Limb Versus Precordial ECG Leads as Improved Predictors of Electrical Cardioversion Outcome in Persistent Atrial Fibrillation

Abstract

Electrical cardioversion (ECV) is an effective and lowcost rhythm control strategy for persistent atrial fibrillation (AF). Because of its limited mid- and long-term success rates, prediction of early failure could avoid patients with reduced chance to maintain sinus rhythm (SR). To this end and due to its proximity to the right atrium, several indices characterizing atrial activity have been proposed based on lead V1. However, information from other leads has been discarded to date. Hence, this work studies how effective some common indices computed over the whole set of 12 standard ECG leads are in predicting ECV outcome. Precisely, amplitude, dominant frequency, and sample entropy were computed from the fibrillatory (f-) waves extracted for each one of 12 standard leads acquired before ECV from 58 patients in persistent AF. The classification between the patients who relapsed to AF and maintained sinus rhythm after a follow-up of 4 weeks achieved by these parameters was better from limb lead II than from V1, thus reporting improvements about 6 and 12%. As a consequence, characterization of f-waves from the more accessible limb lead II has proven to be the best choice to improve AF ECV outcome prediction from the ECG.