High‐Resolution Signal‐Averaged Analysis of Atrial Electromagnetic Characteristics in Patients with Paroxysmal Lone Atrial Fibrillation

Abstract

Clinical subclasses of lone AF seem to possess distinct signal profiles of atrial depolarization. Differences in electrophysiological properties between these subclasses may reflect pathogenetic variation and could have implications on diagnostics and therapy.

Electrophysiological abnormalities in patients with paroxysmal atrial fibrillation in the absence of overt structural heart disease

“…The same findings apply when analysis is restricted to “lone” paroxysmal AF patients, suggesting that even in this specific subgroup, some electrical abnormalities are present making the term “lone” inadequate and obsolete. These results are in agreement with previous studies showing significant modifications in P-wave morphology [8], altered atrial conductive properties [6], [13], [14], [15], [16], prolonged regional refractoriness [14], increased atrial dispersion of refractoriness [17] and shortening of atrial refractory periods [18], in patients with paroxysmal “lone” AF. It has also been shown that these patients have evidence of atrial fibrosis on magnetic resonance imaging [19].…”

The P Wave Time‐Frequency Variability Reflects Atrial Conduction Defects before Paroxysmal Atrial Fibrillation

“…In view of this result, it could be considered that P wave high‐frequency energy analysis could provide additional morphological information to the one revealed by its duration. This finding is clinically relevant because recent works have suggested that P wave duration alteration could not be considered as an unavoidable requirement for AF development To this respect, previous works have shown that patients with lone PAF failed to demonstrate any remarkable P wave prolongation . Similarly, P wave duration has not been predictive of new‐onset AF in patients with congestive heart failure …”

P‐Wave Duration in Lead aVR and the Risk of Atrial Fibrillation in Hypertension

“…PW prolongation is generally accepted as the most reliable noninvasive marker of atrial conduction and it has been associated with a history AF . However, several studies failed to demonstrate significant PW prolongation in patients with AF, and shorter PW duration has been associated with lone AF, suggesting that locally delayed intra‐ and interatrial conduction rather than global conduction slowing may occur. Accordingly, Josephson et al first suggested that biphasic PWs in the right precordial leads may represent an interatrial conduction defect not necessarily associated to left atrial enlargement.…”