Signal-averaged P-wave ECG discriminates between persistent and paroxysmal atrial fibrillation

Reverse Electrical Remodeling of the Atria Post Cardioversion in Patients Who Remain in Sinus Rhythm Assessed by Signal Averaging of the P‐Wave

“…It has been shown to predict development of AF in special subgroups of patients, namely those with hyperthyroidism 8 and postcoronary artery bypass surgery 3 . It has also been shown that patients with persistent and/or permanent AF have longer SAPW duration when compared with those with paroxysmal AF, and that the SAPW duration is predictive of progression from paroxysmal to permanent AF 9,10 . However, there are conflicting data regarding the value of the SAPW to predict recurrence of AF in patients undergoing CV for persistent AF.…”

Noninvasive organization analysis along consecutive episodes of paroxysmal atrial fibrillation

“…Thus, the possibility of getting a priori knowledge on the intra-patient progression of AF disorganization, episode by episode, could be helpful in predicting both the possible termination or perpetuation of the arrhythmia and the timing and progressive advance that turns the arrhythmia from paroxysmal to persistent. This observation could have significant implications in AF management, thus allowing a better selection of patients for the most suitable therapy, like antiarrhythmic drug treatment or the implantation of atrial defibrillators [17]. To this respect, the risk of progression from paroxysmal to persistent AF is significantly higher in patients with a higher rate of disorganization along onward recurrences of AF [18].…”

Spectral turbulence analysis of the signal-averaged electrocardiogram of the atrial activation as predictor of recurrence of idiopathic and persistent atrial fibrillation

“…In time domain, the characterization of an abnormal P-wave has been extensively studied and the criteria for analysis has undergone substantial variations as a consequence of either the averaging protocol or the filter settings employed for analysis [11][12][13][14][15][16][17]. Although, Turitto et al [11] pointed out that the signal-averaged P-wave duration is not adequate to predict recurrence of atrial fibrillation and flutter, recent works are pointing out a moderate predictive capacity of this parameter, with sensitivity and specificity fairly above 70% [12 -14].…”

“…Time domain approaches have been already investigated to this purpose, hitherto with controversial results [11][12][13][14][15][16][17]. Spatial heterogeneity in atrial conduction velocities are partially responsible for reentrant circuits at different sites in both atria and expresses themselves as high-frequency fragmented electrical activity during sinus rhythm, on the P-wave in subjects with frequent recurrence of AF [18].…”