Frontal plane QRS‐T angle predicts early recurrence of acute atrial fibrillation after successful pharmacological cardioversion with intravenous amiodarone

WHAT IS KNOWN AND OBJECTIVE: Although restoration of sinus rhythm is the integral part of the atrial fibrillation (Af) management, recurrence frequency of Af is high after cardioversion. However, little is known about the association of electrocardiography (ECG) parameters with Af recurrence after restoration of sinus rhythm. The present study aimed to investigate whether frontal plane QRS-T (fQRST) angle, as a marker of ventricular repolarization heterogeneity, predicts Af recurrence after successful pharmacological cardioversion. METHODS: One hundred and sixty-five paroxysmal Af patients with an acute Af episode who underwent successful pharmacological cardioversion with intravenous amiodarone infusion were included into the study. Patients were divided into two groups according to presence or absence of in-hospital Af recurrence. The association between fQRST angle and Af recurrence was investigated. RESULTS AND DISCUSSION: Af recurrence was observed in 42 (25.4%) patients. The mean fQRST angle was significantly higher in patients with Af recurrence compared to those without Af recurrence (90 ± 45.8 vs. 51 ± 38.2, p < 0.001). Also, Af recurrence was more frequent in patients who had fQRST angle >90˚, compared to patients with fQRST angle ≤90˚ (54.1% vs. 13.7%, p < 0.001). Moreover, ROC curve analysis demonstrated that an increased fQRST angle >92.5˚ predicted in-hospital Af recurrence with a sensitivity of 76.2% and a specificity of 81.4% (AUC:0.728, p < 0.001). Furthermore, multivariate analysis demonstrated that fQRST angle was an independent predictor of in-hospital Af recurrence after successful pharmacological cardioversion (OR: 1.892, 95% CI: 1.361-2.917, p < 0.001). WHAT IS NEW AND CONCLUSION: As a parameter that can be easily calculated from automated ECG recordings, fQRST angle may be useful in the prediction of early Af recurrence after successful pharmacological cardioversion with amiodarone.