Prediction of Early Reinitiation of Atrial Tachyarrythmias Shortly After Successful Electrical Cardioversion

This study was designed to assess the relationship between the early recurrence of atrial tachyarrhythmia (ERAT) and the pattern of the immediate atrial activities following electrical cardioversion (DC/CVN). We tested the hypothesis that the early atrial activity pattern and time predicted ERAT. We investigated clinical and electrocardiographic variables to predict ERAT in 20 minutes in randomly selected 123 procedures in 123 patients. Electrocardiograms recorded continuously were assessed for PP intervals and the type of atrial activity (sinus, atrial premature, fusion or junctional) for, at most, the first 35 beats following successful electrical cardioversion. No-ERAT group consisted of 101 procedures in 101 patients (mean age 66±13 years) without early recurrence of atrial tachyarrhythmia, whereas ERAT group (n= 22) (mean age 69±11 years) had recurrence within 20 minutes following successful DC/CVN. There was no difference between groups regarding drugs received, including antiarrhythmics. Atrial tachyarrhythmia in the ERAT group recurred in 118±280 seconds (3 sec-20 min). History of hypertension was significantly higher the in ERAT group. Increased pPP50 %, increased PAC/total beat ratio, and minimum PP interval have been found as predictors of ERAT in this study. We concluded that history of hypertension was the only clinical harbinger of ERAT in 20 minutes following successful DC/CVN. Frequent premature atrial activity with shorter coupling interval analyzed from surface ECG may identify a subgroup of patients who may benefit from immediate intervention to prevent from ERAT. Suppression of premature atrial activity during CVN may be a good target in preventing ERAT in this group of patients.