Perceived heart rhythm in relation to ECG findings after direct current cardioversion of atrial fibrillation

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Abstract
Objective: To investigate the agreement between perceived heart rhythm and the ECG-registered heart rhythm, as well as between symptoms and the ECG after direct current (DC) cardioversion of atrial fibrillation (AF). Methods: Consecutive patients with symptomatic AF subjected to DC cardioversion were interviewed about perceived heart rhythm and symptoms one week after restoration of sinus rhythm (SR). An ECG was obtained after the interview. A chance-corrected measure of agreement was calculated by using Cohen’s κ test. Results: 356 patients were enrolled. One week after successful cardioversion 160 patients considered their rhythm to be regular and 222 ECGs showed SR. 130 patients considered their heart rhythm to be regular in agreement with ECG in SR (κ = 0.34, 95% confidence interval (CI) 0.24 to 0.44), indicating a fair agreement. At the same time 59 patients perceived AF and 134 ECGs showed AF. Thirty eight patients perceived AF, in agreement with AF found on their ECG (κ = 0.13, 95% CI 0.02 to 0.25), a poor agreement. 141 of 356 patients reported improvement of symptoms in agreement with SR on their ECG (κ = 0.26, 95% CI 0.15 to 0.36), indicating fair agreement. Perceived SR and improvement of symptoms were strongly associated (n = 129; p < 0.001). Conclusion: Agreement between perceived heart rhythm and ECG, as well as between improvement of symptoms and SR recorded on the ECG, is no more than poor to fair after successful cardioversion of patients with persistent AF. The association between perceived SR and improvement of symptoms is strong. These findings support the need for objective criteria to select patients who would benefit most from rhythm control. They also support the need for further studies on quality of life of patients with AF, with due attention paid to patients’ perception of their cardiac rhythm.

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