Introduction
Electrical cardioversion (ECV) remains a treatment option for atrial fibrillation (AF).The study aimed to find predictors of SR maintenance after ECV using spectral and vector cardiographic (VCG) analysis of ECGs.
Methods
Consecutive patients with AF referred for elective ECV were prospectively enrolled. A digital ECG recording was obtained before the ECV and was analyzed using spectral and VCG analysis.AF activity was analyzed using spectral analysis to determine the dominant frequency (DF), RI (regularity index) and OI (organizational index).QRS complexes were analyzed using vectorcardiography to determine the dXmean, dYmean and dZmean (derivation of VCG signals).Using logistic regression (LR) with backward parameter reduction, separate and combined predictive models of SR maintenance were calculated based on both VCG and spectral analysis of data.
Results
A total of 80 patients were enrolled (age 70.2+10.6 years, 49 (61%) were men, BMI 29.7kg/m2). At the 3month follow-up,AF recurrence was present in 36 patients (45%). Using vector cardiographic parameters, dXmean (OR 2.84, 95% CI 1.04–8.03), p=0.001), dYmean (OR 0.23, 95% CI 0.08–0.64), p <0.001) and dZMean (OR 0.18, 95% CI 0.06–0.61), p<0.001) best predicted the SR maintenance with an area under the curve (AUC) of 0.76.Using spectral analysis parameters, the best predictor was DF (OR 3.07, 95% CI 1.14–8.63), p=0.012) with AUC 0.80.By combining the results of spectral analysis and vector cardiography, an AUC of 0.87 was achieved.
Conclusion
The combination of spectral analysis of AF activity and VCG analysis of QRS complexes provided more accurate predictive information than either analysis alone.
