What is the clinical evidence from this study?

Study design: Cohort. Population: Persistent atrial fibrillation (n=195). Intervention: ECG composite score (notched P-wave, fQRS, ERP) vs. Lower ECG composite score. Primary outcome: Early atrial fibrillation recurrence within 10 days (OR 4.91 per 1-point increase, 95% CI 2.87-8.40, p=<0.001).

What does this research mean for the field?

An ECG composite score consisting of notched P-wave, fragmented QRS, and early repolarization independently predicts early atrial fibrillation recurrence after electrical cardioversion. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate whether standard 12-lead electrocardiographic markers and a composite ECG score predict early recurrence of atrial fibrillation within 10 days following successful electrical cardioversion.

August 30, 2026Annals of Noninvasive ElectrocardiologyOpen Access

Electrocardiographic Predictors of Early Recurrence of Atrial Fibrillation After Electrical Cardioversion

Q: What are the key findings of this study?

An ECG composite score based on notched P-wave, fragmented QRS, and early repolarization pattern independently predicted early atrial fibrillation recurrence within 10 days after electrical cardioversion (OR 4.91 per 1-point increase).

Q: What does this research mean for the field?

An ECG composite score consisting of notched P-wave, fragmented QRS, and early repolarization independently predicts early atrial fibrillation recurrence after electrical cardioversion. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate whether standard 12-lead electrocardiographic markers and a composite ECG score predict early recurrence of atrial fibrillation within 10 days following successful electrical cardioversion.

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Key result

Novel ECG score linked to ~5-fold higher risk of early AF recurrence after cardioversion.

OR 4.91 per 1-point increase
95% CI 2.87-8.40
P<0.001
n=195

Why the study?

Although electrical cardioversion effectively restores sinus rhythm in persistent AF, early recurrence remains common in clinical practice.

Does a higher ECG composite score predict early atrial fibrillation recurrence in patients with persistent atrial fibrillation after successful electrical cardioversion?

Key Points

To evaluate whether standard 12-lead electrocardiographic markers and a composite ECG score predict early recurrence of atrial fibrillation within 10 days following successful electrical cardioversion.
Retrospectively analyzed 195 patients with persistent atrial fibrillation who underwent successful electrical cardioversion.
Assessed post-cardioversion electrocardiograms for notched P-wave, fragmented QRS (fQRS), early repolarization pattern (ERP), and a composite score summing these three markers (0–3 points).
Identified independent predictors of electrocardiographically documented recurrence within 10 days using multivariable logistic regression analysis.
Early recurrence occurred in 51.3% (100/195) of patients, who had higher rates of notched P-wave (76.0% vs. 24.2%, p < 0.001), fQRS (74.0% vs. 57.9%, p = 0.017), and ERP (41.0% vs. 24.2%, p = 0.015).
In multivariable analysis, notched P-wave (OR 11.80, 95% CI 5.51–25.29, p < 0.001), ERP (OR 3.54, 95% CI 1.59–7.90, p = 0.002), and fQRS (OR 2.34, 95% CI 1.08–5.07, p = 0.031) independently predicted recurrence.
The ECG composite score independently predicted early recurrence (OR 4.91 per 1-point increase, 95% CI 2.87–8.40, p < 0.001), demonstrating a stepwise increase in recurrence rates across score categories.

Study Design

Type

Cohort (n=195)

Multicenter

Structured PICO

Does a higher ECG composite score predict early atrial fibrillation recurrence in patients with persistent atrial fibrillation after successful electrical cardioversion?

Population

195 patients with persistent atrial fibrillation (median age 67, 21.5% female) who underwent successful electrical cardioversion, followed for 10 days.

Exposure

Presence of specific 12-lead ECG markers (notched P-wave, fragmented QRS, early repolarization pattern) and a composite ECG score (0-3) recorded immediately after successful electrical cardioversion.

Comparator

Absence of these ECG markers or lower composite ECG score.

Outcome

Early atrial fibrillation recurrence, defined as electrocardiographically documented recurrence within 10 days after electrical cardioversion.

Main Result

Odds Ratio: 4.91 (95% CI 2.87–8.4)

p-value: p=<0.001

Simple 12-lead ECG markers (notched P-wave, fragmented QRS, and early repolarization pattern) assessed immediately after electrical cardioversion can independently predict early recurrence of atrial fibrillation within 10 days.

Limitations

Retrospective single-center study with modest sample size
Continuous rhythm monitoring only during hospitalization
Acute postcardioversion electrophysiological changes not fully accounted for
Left atrial volume index not consistently available
Lack of external validation
Lack of continuous rhythm monitoring after discharge leading to potential underdetection of asymptomatic AF
Potential influence of acute postcardioversion electrophysiological changes, electrical stunning, sedation, or drugs on ECG parameters
Lack of consistent left atrial volume index data
No external validation of the ECG composite score

Implication

ECG score was associated with early AF recurrence post-ECV; hypothesis-generating and requires prospective validation before clinical use.

Abstract

BACKGROUND: Although electrical cardioversion (ECV) effectively restores sinus rhythm in patients with persistent atrial fibrillation (AF), early recurrence after successful ECV remains common in clinical practice. We investigated whether simple 12-lead electrocardiographic markers and a composite ECG score could predict early AF recurrence. METHODS: We retrospectively analyzed 195 patients with persistent AF who underwent successful ECV. Electrocardiograms recorded immediately after ECV were evaluated for notched P-wave, fragmented QRS (fQRS), and early repolarization pattern (ERP). The ECG composite score was defined as the sum of these markers (0-3). Early AF recurrence was defined as electrocardiographically documented recurrence within 10 days after ECV. Multivariable logistic regression analysis was performed. RESULTS: Early AF recurrence occurred in 100 patients (51.3%). AF duration was longer in patients with recurrence (12 [3-57] vs. 5 [2-15] months, p < 0.001). Notched P-wave (76.0% vs. 24.2%, p < 0.001), fQRS (74.0% vs. 57.9%, p = 0.017), and ERP (41.0% vs. 24.2%, p = 0.015) were more frequent in patients with recurrence. In multivariable analysis, notched P-wave (OR 11.80), fQRS (OR 2.34), and ERP (OR 3.54) independently predicted recurrence (all p < 0.05). The ECG composite score was also independently associated with recurrence (OR 4.91 per 1-point increase, p < 0.001), with a stepwise increase in recurrence across score categories. CONCLUSIONS: Simple 12-lead ECG markers and a composite ECG score may help predict early AF recurrence and guide rhythm-control strategies after ECV in patients with persistent AF.

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Published by Annals of Noninvasive Electrocardiology · CC BY

Cite This Study

Yonezu et al. (2026) conducted a cohort in Persistent atrial fibrillation (n=195). ECG composite score (notched P-wave, fQRS, ERP) vs. Lower ECG composite score was evaluated on Early atrial fibrillation recurrence within 10 days (OR 4.91 per 1-point increase, 95% CI 2.87-8.40, p=<0.001). An ECG composite score based on notched P-wave, fragmented QRS, and early repolarization pattern independently predicted early atrial fibrillation recurrence within 10 days after electrical cardioversion (OR 4.91 per 1-point increase).

synapsesocial.com/papers/6a93f0c06c1a8fb52e79d23a https://doi.org/10.1111/anec.70225

Topics

Atrial fibrillation

Persistent AF management

AF ablation outcomes

Anticoagulation in AF

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Implication

ECG score was associated with early AF recurrence post-ECV; hypothesis-generating and requires prospective validation before clinical use.

Electrocardiographic Predictors of Early Recurrence of Atrial Fibrillation After Electrical Cardioversion

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Topics

Electrocardiographic Predictors of Early Recurrence of Atrial Fibrillation After Electrical Cardioversion

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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