Relationship Between Atrial Fibrillation Cardioversion And F Wave Inelectrocardiogram

Objective: To investigate the relationship between atrial fibrillation cardioversion and f wave in electrocardiogram, providing a ordinary and noninvasive method for the clinical prediction and treatment.Methods: We selected 50 cases of patients with atrial fibrillation living in our hospital and divided into two groups according to the size of each indictors, such as f wave discrepancy,f wave amplitude,f wave duration,diameter of the left atrial,left ventricular ejection fraction and plasma BNP level.(f wave duration≥110ms versus f wave duration<110ms; f wave discrepancy<50ms versus f wave discrepancy≥50ms; f wave amplitude≥0.1mv versus f wave amplitude<0.1mv; diameter of the left atrial<40mm versus diameter of the left atrial≥40mm;left ventricular ejection fraction≥50% versus left ventricular ejection fraction <50% ;plasma BNP level<200mmol/L versus plasma BNP level≥200 mmol/L). We observed the rate of atrial fibrillation within 72 hours and calculated the predictive value of indicators for atrial fibrillation cardioversion.Results:①The diversion rate from atrial fibrillation was 69% in group of f wave duration≥110ms versus 35% in group of f wave duration<110ms(P<0.05),55% in group of f wave discrepancy<50 ms versus 24% in group of f wave discrepancy≥50 ms(P<0.05),60% in group of f wave amplitude≥0.1mv versus 28% in group of f wave amplitude<0.1mv(P<0.05),70% in group of the left atrial diameter<40mm versus 22% in group of the left atrial diameter≥40mm(P<0.05),54% in group of left ventricular ejection fraction≥50% versus 15% in group of left ventricular ejection fraction<50%,62% in group of plasma BNP level<200 mmol/L versus 25% in group of plasma BNP level≥200 mmol/L(P<0.05).②Receiver operating characteristic curve show that: area under the curve of f wave duration≥110ms was 0.71, of f wave discrepancy<50 ms was 0.70, of f wave amplitude≥0.1mv was 0.70, of the left atrial diameter<40cm was 0.76,of left ventricular ejection fraction≥50% was 0.70, of plasma BNP level <200mmol/L was 0.73, all larger than 0.7, with P value all less than 0.05. So all of them had diagnostic value to some extent. When the Youden's index index(YI)reach maxism, their cut point were 78ms,42ms,1.0mv,39.5mm,60%,207mmol/L.③Among single risk factor, the specificity,sensitivity,positive predictive value and negative predictive value of f wave duration≥110ms were 41%,86%,69%,65%; the specificity,sensitivity,positive predictive value and negative predictive value of f wave discrepancy<50 ms were 82%,46%,55%,76%; the specificity,sensitivity,positive predictive value and negative predictive value of f wave amplitude≥0.1mv were 68%,64%,60%,72%; the specificity,sensitivity,positive predictive value and negative predictive value of the left atrial diameter<40mm were 73%,75%,70%,78%; the specificity,sensitivity,positive predictive value and negative predictive value of left ventricular ejection fraction≥50% were 91%,39%,54%,85%; the specificity,sensitivity,positive predictive value and negative predictive value of plasma BNP level<200mmol/L were 73%,64%,62%,75%, the sensitivity and negative predictive value of left ventricular ejection fraction≥50% to predict cardioversion of atrial fibrillation was highest, and the specificity and positive value of f wave duration≥110ms to predict cardioversion of atrial fibrillation was highest. Along with more than two risk factors, the specificity and positive predictive value were much higher, but the sensitivity and negative predictive value were much lower.Multiple logistic regression analysis revealed that the f wave amplitude was an independent preditor of cardioversion of atrial fibrillation.④Diameter of the left atrial had the relation with left ventricular ejection fraction(P=0.000,r=-0.568); Left ventricular ejection fraction had the relation with plasma BNP level(P=0.003,r= -0.434); Diameter of the left atrial had the relation with f wave duration(P=0.031,r= -0.309), Diameter of the left atrial had the relation with f wave discrepancy(P=0.004,r= 0.402). Conclusion: F wave characteristics are electrocardiographic markers that can be used for the prediction of cardioversion of atrial fibrillation.