Alternative Time-Domain P-wave Analysis for Precise Information on Substrate Alteration After Pulmonary Vein Isolation for Atrial Fibrillation

Abstract

While P-wave duration (PWD) is primarily employed to observe the atrial substrate alterations after pulmonary vein isolation (PVI) on atrial fibrillation (AF) patients, the acquired information corresponds to the entire atria. Left (LA) and right atrium (RA), though, may be differently affected by PVI, implying the need for different after-PVI handling. In order to clarify this assumption, five-minute lead II recordings from 29 paroxysmal AF patients undergoing first-ever PVI were recruited before and after PVI. PWD was analyzed integrally and in parts, with the first part (P W D1) from the onset to the peak corresponding to RA and the second part (P W D2) to LA depolarization. Time from P-wave onset or offset to the R peak were also calculated (Pon − R and Pof f − R, respectively). Normalization (N) to mitigate heartrate effect was applied. Results before and after PVI were compared with Mann-Whitney U-test (MWU). Median values and variations due to PVI were calculated for all features and compared between PWD and the remaining features via Pearson correlation. After PVI, PWD (−9.84%, p = 0.0085, N : − 17.96%, p = 0.0442) and P W D2 (−22.03%, p = 0.0250, N :− 27.77%, p = 0.0268) were significantly decreased. P W D1 did not shorten significantly (up to −8.96%, p > 0.05 at either cases). P W D − P W D1 (ρ > 74.5%, p < 0.0001) showed higher correlation than P W D − P W D2 (ρ > 41.9%, p < 0.0001) in before and after PVI analysis but not for PVIrelated variation (ρP W D−P W D 1 = 54.0%, p = 0.0114 and ρP W D−P W D 2 = 61.4%, p = 0.0031). While RA depolarization time is more in line with PWD analysis, the effect of PVI in PWD is more coherent with LA's findings. Additionally, PWD shortening is only observed in the LA. Therefore, LA is crucial for the assessment of the atrial substrate alteration after PVI and its analysis should be considered by future studies.