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We have reported on a larger number of patients than most studies in this field of investigation. An abnormally prolonged PWd (40 ms) has previously been reported to differentiate patients with lone paroxysmal AF from control subjects.[14] Our findings extend this observation by showing that increased PWd identifies those at risk of recurrent AF within 1 month after ECV and contributes to the very limited available data on this population.[16] It is well known that AF is more common in the elderly.[17] In elderly patients with AF, the collagen content of the myocardium is increased.[18] Dispersion of refractoriness is enlarged and impulse propagation fragmented. Dilatation as well as fibrosis of the atria http://www.selleckchem.com/products/a-1331852.html increases with age.[19] All of these structural changes promote slow and inhomogeneous atrial conduction and provide a substrate for AF. In our study, PWd http://www.selleck.cn/products/PLX-4720.html increased with age. Recurrent AF patients who had an increased PWd tended to be older, and had greater left atrial diameter and P-max compared with those who had a PWd http://www.selleckchem.com/products/avelestat-azd9668.html delayed atrial conduction in specific populations.[15] Our data, albeit using different measures of atrial electrical heterogeneity, support this work suggesting that greater predictive value should be attributed to P-wave analysis. To date, P-wave signal averaging has received less attention than signal averaging of the QRS complex. The measurement and use of atrial electrical heterogeneity indices have not yet reached full maturity and other methods, such as signal average PWd, are likely to emerge that will supersede those used in our study. Our study identified P-max as an independent predictor of early recurrent AF following ECV and showed that it correlated moderately well with left atrial diameter. This is in keeping with the results of previous studies and with theoretical considerations. The capability of the atria to support AF depends on their ability to contain a stable population of wavelets of depolarization. Either dilatation of the atria, slowing of intra- and interatrial conduction, or some combination of these is needed to allow AF to be persistent. Both dilatation of the atria and slowing of conduction should result in prolongation of the P-wave duration. P-max should therefore contain more information on the vulnerability to AF than any single measurement of atrial anatomy or conduction velocity.