Key result
Extended ECG improves classification of paroxysmal versus persistent AF over standard 10-second ECG.
Why the study?
The added value of extended ECG recordings (longer recordings from more sites) to characterize atrial conduction properties had not been systematically explored.
Does an extended ECG improve the classification of paroxysmal versus persistent atrial fibrillation compared to a standard 12-lead ECG in patients scheduled for AF ablation?
Observational (n=247)
No
Does an extended ECG improve the classification of paroxysmal versus persistent atrial fibrillation compared to a standard 12-lead ECG in patients scheduled for AF ablation?
An extended ECG with additional leads and a 5-minute recording time significantly improves the ability to classify paroxysmal versus persistent atrial fibrillation compared to a standard 10-second 12-lead ECG.
May aid pre-ablation AF classification; hypothesis-generating and requires prospective validation before practice change.
Background The standard 12-lead ECG has been shown to be of value in characterizing atrial conduction properties. The added value of extended ECG recordings (longer recordings from more sites) has not been systematically explored yet. Objective The aim of this study is to employ an extended ECG to identify characteristics of atrial electrical activity related to paroxysmal vs. persistent atrial fibrillation (AF). Methods In 247 participants scheduled for AF ablation, an extended ECG was recorded (12 standard plus 3 additional leads, 5 min recording, no filtering). For patients presenting in sinus rhythm (SR), the signal-averaged P-wave and the spatiotemporal P-wave variability was analyzed. For patients presenting in AF, f-wave properties in the QRST (the amplitude complex of the ventricular electrical activity: Q-, R-, S-, and T-wave)-canceled ECG were determined. Results Significant differences between paroxysmal ( N = 152) and persistent patients with AF ( N = 95) were found in several P-wave and f-wave parameters, including parameters that can only be calculated from an extended ECG. Furthermore, a moderate, but significant correlation was found between echocardiographic parameters and P-wave and f-wave parameters. There was a moderate correlation of left atrial (LA) diameter with P-wave energy duration ( r = 0.317, p < 0.001) and f-wave amplitude in lead A3 ( r = −0.389, p = 0.002). The AF-type classification performance significantly improved when parameters calculated from the extended ECG were taken into account [area under the curve (AUC) = 0.58, interquartile range (IQR) 0.50–0.64 for standard ECG parameters only vs. AUC = 0.76, IQR 0.70–0.80 for extended ECG parameters, p < 0.001]. Conclusion The P- and f-wave analysis of extended ECG configurations identified specific ECG features allowing improved classification of paroxysmal vs. persistent AF. The extended ECG significantly improved AF-type classification in our analyzed data as compared to a standard 10-s 12-lead ECG. Whether this can result in a better clinical AF type classification warrants further prospective study.
No takes yet. Share an insight, caveat, or question.
Zink et al. (2022) conducted an observational in Atrial Fibrillation (n=247). Extended ECG (12 standard plus 3 additional leads) vs. Standard 10-s 12-lead ECG was evaluated on Classification of paroxysmal vs. persistent AF (Area Under the Curve) (p=<0.001). Extended ECG significantly improved the classification of paroxysmal versus persistent atrial fibrillation compared to a standard 10-second 12-lead ECG (AUC 0.76 vs 0.58, p<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: