P Wave Indices to Predict Atrial Fibrillation Recurrences Post Pulmonary Vein Isolation

Abstract

BackgroundP-wave indices are appealing markers for predicting atrial fibrillation (AF) recurrences post ablation.ObjectiveThis study evaluates the value of P wave indices to predict recurrences post pulmonary vein isolation (PVI) in patients with paroxysmal AF.MethodsWe selected 198 patients (57 ± 8 years, 150 males) with symptomatic drug-refractory paroxysmal AF undergoing PVI in our hospital. A 12-lead electrocardiogram was used to measure P wave duration in lead II, P wave terminal force (PWTF) in lead V1, P wave axis and dispersion.ResultsDuring a follow-up of 9 ± 3 months, recurrences occurred in 60 (30.3%) patients. The patients that had AF recurrence had longer mean P wave duration (122.9 ± 10.3 vs 104.3 ± 14.2 ms, p < 0.001), larger P wave dispersion (40.7 ± 1.7 ms vs 36.6 ± 3.2 ms, p < 0.001). P wave duration ≥ 125 ms has 60% sensitivity, 90% specificity, positive predictive value (PPV) of 72% and negative predictive value (NPV) of 83.7%, whereas P wave dispersion ≥ 40 ms has 78% sensitivity, 67% specificity, PPV of 51% and NPV of 87.6% 48/66 (72.7%) patients with PWTF ≤ - 0.04 mm/second vs 12/132(9%) with PWTF > -0.04 mm/second showed recurrence of AF (p < 0.001). P wave axis was not different between two groups. On multivariate analysis, P wave indices were not independent from left atrial size and age.ConclusionsP wave duration ≥ 125 ms, P wave dispersion ≥ 40 ms and PWTF in V1 ≤ - 0.04 mm/sec are good clinical predictors of AF recurrences post PVI in patients with paroxysmal atrial fibrillation; however they were not independent from left atrial size and age.

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

“…We included twelve studies for qualitative synthesis, and twelve studies were available for meta‐analysis. There were 1,482 patients with AF post‐PVI from twelve cohort studies (Blanche, Tran, Rigamonti, Burri, & Zimmermann, ; Caldwell et al, ; Hagiwara et al, ; Weber et al, ; Knecht et al, ; Masuda et al, ; Mugnai et al, ; Nakatani et al, ; Ogawa et al, ; Okumura et al, ; Salah et al, ; Wu et al, ; Table ). The subjects had either persistent or paroxysmal AF, and standard 12‐lead ECG measured the PWD in seven studies and signal‐averaged ECG in four studies.…”

“…Ten studies reported a statistically significant difference between the mean PWD of subjects with recurrent AF and those without (Blanche et al, ; Caldwell et al, ; Hagiwara et al, ; Mugnai et al, ; Nakatani et al, ; Ogawa et al, ; Okumura et al, ; Salah et al, ; Wu et al, ). Pooled mean difference of P‐wave duration in subjects with recurrent AF and non‐recurring AF was 12.54 ms [8.76–16.31]; p < 0.001 and high heterogeneity I 2 78%, p < 0.001 (Figure ).…”

“…Studies by Caldwell et al, Jadidi et al, Masuda et al, and Mugnai et al reported that a prolonged PWD has a promising OR ranging from 2.41 to 5.97 in predicting the recurrence of AF in post‐PVI patients (Caldwell et al, ; Weber et al, ; Mugnai et al, ). Four studies reported sensitivity of 60%–93%, specificity of 53%–90%, positive predictive value (PPV) of 36%–72%, negative predictive value (NPV) of 76%–96%, and area under curve (AUC) of 0.695–0.858 (Blanche et al, ; Weber et al, ; Mugnai et al, ; Nakatani et al, ; Okumura et al, ; Salah et al, ; Wu et al, ). Quantitative synthesis was done by including five studies with pooled OR of 5.07 [3.43–7.49]; p < 0.001 and low–moderate heterogeneity I 2 45%, p = 0.12 (Figure a; Caldwell et al, ; Weber et al, ; Masuda et al, ; Mugnai et al, ; Okumura et al, ).…”

“…There is no established tool to predict the AF recurrence after PVI. The atrial substrate remodeling resulted in conduction delay and an enlarged atrium which might be reflected by prolonged P‐wave duration (PWD) on the electrocardiogram (ECG) (Caldwell et al, ; Weber et al, ; Mugnai et al, ; Salah, Zhou, Liu, & Yan, ). A PWD in sinus rhythm pre‐ablation has been hypothesized to be a non‐invasive ECG marker associated with increased AF recurrence after PVI (Caldwell et al, ; Weber et al, ; Mugnai et al, ; Salah et al, ; Wu et al, ).…”

Levels of uric acid and increased diastolic blood pressure: Risk factors for atrial fibrillation in patients older than 60 years

“…Some have been proposed, such as maximum (Pmax) 9 and minimum P-wave duration, 10 P-wave terminal force in lead V1 11 and P-wave dispersion (PWD). [12][13][14][15] Although AF has been associated with increased blood pressure (BP) and UA levels, there are still no studies worldwide that address the relation between Pmax plus PWD and BP plus UA in patients over 60 years of age, in whom there is an increased risk of AF. Taking these elements into account, our study aimed to characterize Pmax and PWD according to BP and UA levels in geriatric patients in a health clinic.…”