Association of Selvester QRS score with AF recurrence after electrical cardioversion

Atrial fibrillation (AF) recurrence after direct current cardioversion (DCCV) remains a clinically important challenge. The Selvester QRS scoring system estimates myocardial fibrosis burden and may carry predictive value for arrhythmia recurrence. This study investigated whether the Selvester QRS score predicts AF recurrence within one year after successful DCCV.

In this retrospective single-centre observational study, 506 patients with persistent AF who underwent successful DCCV between January 2022 and December 2024 were retrospectively reviewed. The Selvester QRS score was computed from the baseline 12‑lead ECG. Patients were followed for 12 months for AF recurrence. Independent predictors were identified by multivariate logistic regression. Receiver operating characteristic (ROC) analysis was used to determine the optimal Selvester score cutoff.

AF recurred in 144 patients (28.5%) within 12 months. The Selvester QRS score was significantly higher in the recurrence group (5.94 ± 3.67 vs. 0.85 ± 1.41; p < 0.001). ROC analysis demonstrated excellent discriminative performance (AUC 0.923; 95% CI 0.895-0.951). A cutoff score ≥ 3 yielded sensitivity 81.9%, specificity 86.5%, positive predictive value 70.7%, and negative predictive value 92.3%. Multivariate logistic regression identified the Selvester QRS score (OR 3.205; 95% CI 2.525-4.068), tricuspid regurgitation grade (OR 3.667), hypertension (OR 7.121), female sex (OR 5.587), and left ventricular ejection fraction (OR 1.085) as independent predictors of recurrence.

The Selvester QRS score is a readily available, non-invasive ECG-based predictor of AF recurrence after cardioversion. A score ≥ 3 identifies patients at high risk with excellent diagnostic accuracy and may guide risk stratification and antiarrhythmic therapy decisions.