P-wave duration and atrial fibrillation recurrence after catheter ablation: a systematic review and meta-analysis

Abstract

Aims Atrial fibrillation (AF) is a global health problem with high morbidity and mortality. Catheter ablation (CA) can reduce AF burden and symptoms, but AF recurrence (AFr) remains an issue. Simple AFr predictors like P-wave duration (PWD) could help improve AF therapy. This updated meta-analysis reviews the increasing evidence for the association of AFr with PWD and offers practical implications. Methods and results Publication databases were systematically searched and cohort studies reporting PWD and/or morphology at baseline and AFr after CA were included. Advanced interatrial block (aIAB) was defined as PWD ≥ 120 ms and biphasic morphology in inferior leads. Random-effects analysis was performed using the Review Manager 5.3 and R programs after study selection, quality assessment, and data extraction, to report odds ratio (OR) and confidence intervals. : Among 4175 patients in 22 studies, 1138 (27%) experienced AFr. Patients with AFr had longer PWD with a mean pooled difference of 7.8 ms (19 studies, P < 0.001). Pooled OR was 2.04 (1.16–3.58) for PWD > 120 ms (13 studies, P = 0.01), 2.42 (1.12–5.21) for PWD > 140 ms (2 studies, P = 0.02), 3.97 (1.79–8.85) for aIAB (5 studies, P < 0.001), and 10.89 (4.53–26.15) for PWD > 150 ms (4 studies, P < 0.001). There was significant heterogeneity but no publication bias detected. Conclusion P-wave duration is an independent predictor for AF recurrence after left atrium ablation. The AFr risk is increasing exponentially with PWD prolongation. This could facilitate risk stratification by identifying high-risk patients (aIAB, PWD > 150 ms) and adjusting follow up or interventions.

Electrocardiographic markers of subclinical atrial fibrillation detected by implantable loop recorder: insights from the LOOP Study

“…Previous research has identified various ECG parameters as predictors of incident AF as well as AF recurrence after ablation. 6–17 , 21 , 22 Especially the use of P -wave parameters has been suggested by the recent consensus document from the International Society of Electrocardiology for detection of pathological changes in atria and thereby AF risk stratification. 6 Indded, through an AI-based algorithm, a non-randomized, interventional trial also confirmed the utility of sinus rhythm ECG features in the selection of patients with high AF risk for screening.…”

“…Given the axis of Lead I running in parallel to Bachmann’s bundle, a reduction of PWV might, therefore, represent impaired conduction in Bachmann’s region, similarly to the proposed mechanism underlying IAB that has been linked to incident AF in previous studies. 15 , 21 , 22 For PWD and PR interval, Nielsen et al . 11 , 17 demonstrated a U-shaped relationship between both parameters and incident AF in the Copenhagen ECG Study of nearly 300 000 subjects.…”

Catheter ablation of atrial fibrillation in the young: a systematic review and meta-analysis

“…Secondly, in older patients, other poor ablation risk factors such as hypertension, obesity, and obstructive sleep apnea syndrome were higher. However, shorter preablation presence of these risk factors and easier lifestyle modifications after PVI in young patients may explain the differences with old patients [21,22] . Concerning complications, the overall complication rate was low.…”

Electro-Mechanical Alterations in Atrial Fibrillation: Structural, Electrical, and Functional Correlates

“…P wave duration independently predicts AF recurrence after radiofrequency (RF) ablation. The risk of AF recurrence increases substantially with a P wave duration > 150 ms [47].…”