Noninvasive Assessment of Atrial Substrate Change after Wide Area Circumferential Ablation: A Comparison with Segmental Pulmonary Vein Isolation

Redfearn, Damián P.; Skanes, Allan C.; Gula, Lorne J.; Griffith, Michael; Marshall, Howard; Stafford, Peter J.; Krahn, Andrew D.; Yee, Raymond; Klein, George J.

doi:10.1111/j.1542-474x.2007.00182.x

Cited by 22 publications

(10 citation statements)

References 35 publications

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“…The results of these studies are conflicting. Some studies showed that is the technique was useful to predict recurrences [25], 26], [27] whereas other data did not [28], probably because of different study design, small numbers of patients, various SAECG methodologies and variable definition of recurrences. The high recurrence rate in our study was essentially due to use of the nMARQ catheter with low power settings, which was probably a confounding factor with reconnection of the pulmonary veins.…”

Section: Discussionmentioning

confidence: 99%

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

Arroja

Burri

Park

et al. 2016

Indian Pacing and Electrophysiology Journal

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PurposeThe aim of the present study was to define the atrial electrical substrate in patients with paroxysmal atrial fibrillation (AF) occurring in the absence of overt structural heart disease and to assess if electrophysiological parameters could predict AF recurrence after radiofrequency ablation in this population.Methods and results45 consecutive patients (39 male, age 59 ± 10 years) with paroxysmal AF and without overt structural heart disease, referred for radiofrequency catheter ablation, were prospectively enrolled. A cohort of 12 age-matched patients without a history of AF, served as a control group. Atrial electrical substrate was assessed by P-wave signal-averaging, intracardiac conduction delays and refractory periods. Total P wave duration during signal-averaging was longer in patients with paroxysmal AF than in controls (140 ± 19 ms vs 123 ± 13 ms, p = 0.004). Patients with paroxysmal AF showed an increase in right intra-atrial (40.2 ± 11.3 ms vs 31.7 ± 11.8 ms, p = 0.02) and inter-atrial conduction delays (87.93 ± 22.0 ms vs 65.3 ± 15.6 ms, p = 0.001) in sinus rhythm. Refractory periods in the right atrium were longer in patients with paroxysmal AF (265 ± 44 ms vs 222 ± 32 ms, p = 0.002). After ablation, 22 patients had AF recurrence but showed no differences in electrophysiological parameters compared to patients without recurrence.ConclusionElectrophysiological abnormalities are present in patients with paroxysmal AF without overt structural heart disease. Neither signal-averaged P-wave duration nor intracardiac atrial electrophysiology could predict arrhythmia recurrence after pulmonary vein isolation.

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Section: Discussionmentioning

confidence: 99%

“…A few studies [25], 26], [27], [28] have used the SAECG to study the effect of RF catheter ablation on the P-wave and to predict the risk of recurrences after ablation. The results of these studies are conflicting.…”

Section: Discussionmentioning

confidence: 99%

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

Arroja

Burri

Park

et al. 2016

Indian Pacing and Electrophysiology Journal

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“…Hence, re‐conduction is not the only possible cause (Callans et al, ; Gerstenfeld, Callans, Dixit, Zado, & Marchlinski, ). These causes include extra PV foci, atrial substrate remodeling leading to conduction delays (Van Beeumen, Houben, Tavernier, Ketels, & Duytschaever, ; Callans et al, ; Gerstenfeld et al, ; Ogawa et al, ; Redfearn et al, ).…”

Section: Introductionmentioning

confidence: 99%

Prolonged P‐wave duration in sinus rhythm pre‐ablation is associated with atrial fibrillation recurrence after pulmonary vein isolation—A systematic review and meta‐analysis

Pranata

Yonas

Vania

2019

Noninvasive Electrocardiol

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Introduction: A prolonged P-wave duration (PWD) in sinus rhythm pre-ablation has been hypothesized to be a non-invasive ECG marker associated with increased atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). This systematic review and meta-analysis will assess the latest evidence on the association of prolonged PWD pre-ablation with AF recurrence after PVI.Hypothesis: Prolonged PWD pre-ablation is associated with AF recurrence after PVI. Methods:The inclusion criteria for this study are all cohort studies that assess prolonged PWD on ECG during sinus rhythm pre-ablation and its association with AF recurrence in post-PVI patients.Results: There were 1,482 patients with AF post-PVI from twelve cohort studies. The cut-off points for prolonged PWD ranges from >120 ms to >150 ms. Meta-analysis on six studies showed a pooled mean difference of PWD in subjects with recurrent AF and non-recurring AF was 12.54 ms [8.76-16.31], p < 0.001; I 2 78%. Pooled odds ratio was 4.17 [2.10-8.31], p < 0.001; I 2 72% and pooled hazard ratio was 1.93 [1.10-3.39], p = 0.02; I 2 80%. Upon subgroup analysis, the association between prolonged PWD and AF recurrence was significant in signal-averaged ECG, 12-lead ECG, paroxysmal AF, >120-130 ms, and >140-150 ms PWD cut-off point subgroups.Conclusion: These findings suggest that prolonged PWD with a cutoff of >120 ms to >150 ms in sinus rhythm before ablation may be associated with AF recurrence after PVI regardless of age, gender, left atrial size, and the presence of structural heart disease. We also encouraged further studies that investigate predicting models to include prolonged PWD as one of their parameters. K E Y W O R D Satrial fibrillation, atrial fibrillation recurrence, catheter ablation, prolonged P-wave duration, pulmonary vein isolation

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“…A previous mechanistic study had shown that PVI performed by the WACA technique was likely to cause greater atrial remodeling, as demonstrated by surrogate electrophysiological parameters (signal averaged P-wave duration), compared to a segmental approach. The better success rates associated with the WACA technique was attributed to a greater degree of modification of the atrial substrate (positive remodeling) compared to the segmental PVI technique [9]. The fact that all subjects in the current study underwent PVI using the WACA technique should have resulted in nearly similar extent of atrial substrate modification after catheter ablation and should not have influenced the incidence of AF recurrence.…”

Section: Electrophysiological Parameters As Surrogates For Atrial Remmentioning

confidence: 75%

Electrophysiological abnormalities in subjects with lone atrial fibrillation – Too little, too late?

Nair

Nery

Redpath

et al. 2016

Indian Pacing and Electrophysiology Journal

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Noninvasive Assessment of Atrial Substrate Change after Wide Area Circumferential Ablation: A Comparison with Segmental Pulmonary Vein Isolation

Abstract: HR recordings exhibit change in HRV after WACA and PVI. Marked change in both HRV and SAPW is observed after WACA. SAPW variables provide a measure of atrial substrate change after WACA unrelated to autonomic denervation.

Cited by 22 publications

References 35 publications

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

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

Prolonged P‐wave duration in sinus rhythm pre‐ablation is associated with atrial fibrillation recurrence after pulmonary vein isolation—A systematic review and meta‐analysis

Electrophysiological abnormalities in subjects with lone atrial fibrillation – Too little, too late?

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