Electrocardiographic Predictors of Early Recurrence of Atrial Fibrillation After Electrical Cardioversion

Although electrical cardioversion (ECV) effectively restores sinus rhythm in patients with persistent atrial fibrillation (AF), early recurrence after successful ECV remains common in clinical practice. We investigated whether simple 12-lead electrocardiographic markers and a composite ECG score could predict early AF recurrence.

We retrospectively analyzed 195 patients with persistent AF who underwent successful ECV. Electrocardiograms recorded immediately after ECV were evaluated for notched P-wave, fragmented QRS (fQRS), and early repolarization pattern (ERP). The ECG composite score was defined as the sum of these markers (0-3). Early AF recurrence was defined as electrocardiographically documented recurrence within 10 days after ECV. Multivariable logistic regression analysis was performed.

Early AF recurrence occurred in 100 patients (51.3%). AF duration was longer in patients with recurrence (12 [3-57] vs. 5 [2-15] months, p < 0.001). Notched P-wave (76.0% vs. 24.2%, p < 0.001), fQRS (74.0% vs. 57.9%, p = 0.017), and ERP (41.0% vs. 24.2%, p = 0.015) were more frequent in patients with recurrence. In multivariable analysis, notched P-wave (OR 11.80), fQRS (OR 2.34), and ERP (OR 3.54) independently predicted recurrence (all p < 0.05). The ECG composite score was also independently associated with recurrence (OR 4.91 per 1-point increase, p < 0.001), with a stepwise increase in recurrence across score categories.

Simple 12-lead ECG markers and a composite ECG score may help predict early AF recurrence and guide rhythm-control strategies after ECV in patients with persistent AF.