Effectiveness of P-wave ECG index and left atrial appendage volume in predicting atrial fibrillation recurrence after first radiofrequency catheter ablation

Abstract

Background The primary aim was to observe the predictive value of P-wave ECG index and left atrial appendage volume (LLAV) for atrial fibrillation recurrence after first radiofrequency catheter ablation. Methods A total of 196 patients with paroxysmal atrial fibrillation were enrolled. The preoperative LLAV was measured by cardiac enhanced CT. The P-wave ECG index including minimum P-wave duration (P-min), maximum P-wave duration (P-max), mean P-wave duration (mPWD), P-wave dispersion (PWD), P-wave terminal force in lead V1 (PtfV1), PR interval prolongation, and interatrial block (IAB) were analyzed and recorded in 12-lead ECG of sinus rhythm. Results According to the follow-up results, the patients were divided into two groups: the non-recurrence group and the recurrence group. P-min, PWD, P-max, PtfV1 ≥ 0.04 mV·s, PR interval prolongation, and the ratio of first and third-degree IAB in the recurrence group were higher than those in the non-recurrence group, with significant statistical differences (P < 0.05). Kaplan–Meier curve analysis was performed on time to atrial fibrillation recurrence after catheter ablation when PtfV1 ≥ 0.04 mv s by comparison between groups (Log Rank test: 2 = 4.739, P < 0.001). Kaplan–Meier curve analysis showed that the survival rate without recurrence of atrial fibrillation after catheter ablation was lower when the LLAV exceeded 8.0 mL (log-rank test P < 0.001). Conclusion PWD, P-max, PtfV1, PR interval prolongation, first and third-degree IAB, and LLAV can effectively predict atrial fibrillation recurrence after radiofrequency catheter ablation. The combination might be a valid and alternative independent predictor of recurrence.

Left atrial appendage function and structure predictors of recurrent atrial fibrillation after catheter ablation: A meta-analysis of observational studies

“…Although the changes in the LAA are closely related to the left atrium, LAA function and structure proved to be strong predictors of AF recurrence after controlling for left atrial structure and related clinical factors in our included study ( 29 , 61 ). The tissue characteristics of the LAA differ from those of the left atrium and there is a large amount of pectinate muscle that can speed up atrial beats, resulting in faulty electrophysiological features between the LAA and left atrium ( 62 , 63 ).…”

Regional left atrial conduction velocity in the anterior wall is associated with clinical recurrence of atrial fibrillation after catheter ablation: efficacy in combination with the ipsilateral low voltage area

“…Pulmonary vein isolation (PVI) is an essential approach, and its electric isolation from the left atrium (LA) achieves a high rate of freedom from AF. However, AF recurrence often occurs, which is not only due to pulmonary vein (PV) reconnection but also an additional arrhythmogenic atrium responsible for AF maintenance [1,2]. Atrial substrate remodeling progresses with aging, the persistence of AF, heart failure, and cardiovascular risk factors [3][4][5].…”

Atrial late potentials are associated with atrial fibrillation recurrence after catheter ablation

“…The most common arrhythmogenic substrate is structural remodeling in the form of LA enlargement. PWD on the surface 12‐lead ECG has also been described to be associated with AF recurrence after CA 18,19 . A long PWD is reported to be associated with an enlarged LA 20 and atrial conduction disturbances 21 .…”