A new method to assess sinus rhythm maintenance likelihood before electrical cardioversion of persistent atrial fibrillation

For many patients in persistent Atrial Fibrillation (AF), normal sinus rhythm (NSR) restoration use to be required to reduce the risk of stroke and improve cardiac output. Electrical cardioversion (ECV) is the most effective alternative to revert AF to sinus rhythm. However, because of the high risk of AF recurrence (especially during the first 2 weeks following the procedure) and because of potential collateral effects of ECV, it is clinically important to predict NSR maintenance after ECV before it is attempted. Thereby, the aim of this work is to obtain a robust and non-invasive predictor of NSR maintenance after ECV. The organization degree of the atrial activity (AA) obtained from surface electrocardiographic (ECG) recordings was estimated using a non-linear regularity index because it can be hypothesized that AF recurrence can be greater in those patients who present a highly disorganized AA. With the proposed strategy, 90.24% sensitivity and 78.57% specificity were obtained. Therefore, therapeutic interventions for the treatment of persistent AF could be improved, since unsuccessful electrical cardioversion and the consequent risks for the AF patients could be avoided.