Noninvasive Assessment of Acute Changes in Atrial Electrophysiology After Cardioversion by Signal-Averaged P-Wave Electrocardiography

Background: Atrial remodeling secondary to atrial fibrillation (AF) may be important in the arrhythmogenic process. Unfortunately, the study of electrophysiologic remodeling in humans has been limited by the invasive nature of most tests of electrophysiologic characteristics. We sought to determine whether changes in atrial electrophysiology occur acutely (within the first hour) after cardioversion and whether these changes could be detected noninvasively by measuring the signal‐averaged P‐wave. Methods: The filtered P‐wave duration (FPD) was measured by signal‐averaged electrocardiography (ECG) at 20 and 60 minutes after cardioversion in 46 patients with AF, and the difference between the two values was calculated. The root‐mean‐square voltage of the terminal 40 ms of the signal‐averaged P‐wave at 20 and 60 minutes and the difference between them were also determined. Results: The FPD at 20 minutes was significantly different from that at 60 minutes (153.0 ± 19.1 vs 159.7 ± 24.8 ms; P = 0.02). In a univariate linear regression model, none of the clinical variables studied was significantly associated with the change in FPD. The root‐mean‐square voltage at 20 minutes was not significantly different from that at 60 minutes (5.8 ± 3.0 vs 5.5 ± 2.7; P = 0.14). Conclusions: We conclude that significant changes in atrial electrophysiology occur within the first hour after cardioversion of AF. These changes can be detected by measuring the FPD.