Prevalence and Significance of Focal Sources of Atrial Arrhythmia in Patients Undergoing Cardioversion of Persistent Atrial Fibrillation


  • Drs. Todd, Fynn, and Hobbs are supported by the British Heart Foundation.

Address for correspondence: Clifford J. Garratt, D.M., Manchestar Heart Centre. Oxford Road, Manchester M13 9WL., United Kingdom. Fax:44-161 276 4443; E-mail:


Atrial Arrhythmias After Cardioversion of AF. Introduction: Recent reports have highlighted the importance of focal atrial arrhythmias as a curable cause fur a group of patients with frequently recurrent paroxysmal atrial fibrillation (AF). The importance of this arrhythmia mechanism in the general population of patients with persistent AF is unknown.

Methods and Results: After successful internal cardioversion of 50 consecutive patients with persistent AF (mean age 60 years, mean duration of AF 26 months), endocardial activity in the immediate postcardioversion period was analyzed for the presence of focal atria activity. Postcardioversion atrial arrhythmias were considered to be focal if there was evidence of a localized source of repetitive early atrial activation, either in the form of (1) self-terminating monomorphic atrial tachycardia (at least five heats) or (2) recurrences of AF with an initial atrial activation sequence (first five beats) that was both monomorphic and reproducible with repeated recurrences. Evidence for a focal atrial arrhythmia was present in 20 of the total group of 50 patients (40%). Multivariate analysis of clinical characteristics revealed the diagnosis of lone AF as the only independent predictor of a focal source of AF (P = 0.028). Thirty-nine patients were discharged from hospital in sinus rhythm. At 1-month follow-up. 25 (64%) of these 39 patients had suffered AF recurrence. The only significant predictor of AF recurrence was evidence of a focal source of atrial arrhythmia immediately after cardioversion, with a relative risk of 1.73 (range 1.1 to 2.7: P = 0.015).

Conclusion: Focal atrial arrhythmias are common in patients presenting with “idiopathic” persistent AF, suggesting a possible causative role in the generation of this common arrhythmia.