Value of P-wave signal averaging to predict atrial fibrillation recurrences after pulmonary vein isolation

Blanche, C; Tran, Nam; Rigamonti, Fabio; Burri, Haran; Zimmermann, Marc

doi:10.1093/europace/eus251

Cited by 51 publications

(54 citation statements)

References 33 publications

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“…Although this technique is still not widely used, it confirms that prolonged P-wave duration probably reflects inter- and/or intra-atrial conduction delays and could be related to the extent of atrial scarring and fibrosis, as shown by the longer P-wave duration in patients with recurrent AF 12 .…”

Section: Discussionmentioning

confidence: 72%

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

Ahmed¹,

Zhou²,

Liu³

et al. 2013

Arquivos Brasileiros De Cardiologia

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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.

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Section: Discussionmentioning

confidence: 72%

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

Ahmed¹,

Zhou²,

Liu³

et al. 2013

Arquivos Brasileiros De Cardiologia

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“…To improve its signal-to-noise ratio, a signal-averaging approach is used. This technique has been widely considered for P-wave characterization, thus revealing clinically useful information, such as the identification of patients prone to PAF [41] or the prediction of AF recurrence after electrical cardioversion [42] or catheter ablation [43].…”

Section: Introductionmentioning

confidence: 99%

Wavelet Entropy Automatically Detects Episodes of Atrial Fibrillation from Single-Lead Electrocardiograms

Rodenas

García

Alcaraz

et al. 2015

Entropy

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This work introduces for the first time the application of wavelet entropy (WE) to detect episodes of the most common cardiac arrhythmia, atrial fibrillation (AF), automatically from the electrocardiogram (ECG). Given that AF is often asymptomatic and usually presents very brief initial episodes, its early automatic detection is clinically relevant to improve AF treatment and prevent risks for the patients. After discarding noisy TQ intervals from the ECG, the WE has been computed over the median TQ segment obtained from the 10 previous noise-free beats under study. In this way, the P-waves or the fibrillatory waves present in the recording were highlighted or attenuated, respectively, thus enabling the patient's rhythm identification (sinus rhythm or AF). Results provided a discriminant ability of about 95%, which is comparable to previous works. However, in contrast to most of them, which are mainly based on quantifying RR series variability, the proposed algorithm is able to deal with patients under rate-control therapy or with a reduced heart rate variability during AF. Additionally, it also presents interesting properties, such as the lowest delay in detecting AF or sinus rhythm, the ability to detect episodes as brief as five beats in length or its integration facilities under real-time beat-by-beat ECG monitoring systems. Consequently, this tool may help clinicians in the automatic detection of a wide variety of AF episodes, thus gaining further knowledge about the mechanisms initiating this arrhythmia.

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“…A cutoff value of ≥ 5 ms for the reduction in the P-wave had a sensitivity of 92 and a speci city of 71 to predict a good clinical outcome. For that reason, shortening of the FPD after PVI was reported to be a predictor of successful AF ablation 16,17 . In the present study, the results were the opposite of those reported in these previous studies.…”

Section: Discussionmentioning

confidence: 99%

New Parameter to Predict Recurrence of Paroxysmal Atrial Fibrillation after Pulmonary Vein Isolation by the P-Wave Signal-Averaged Electrocardiogram

Munetsugu

Kawamura

Tanno

et al. 2017

Showa Univ J Med Sci

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: Noninvasive methods for predicting the recurrence of atrial fibrillation AF after initial pulmonary vein isolation PVI have not been well described. The aim of the present study was to evaluate the usefulness of the P-wave signalaveraged electrocardiogram P-SAECG in predicting the recurrence of AF after initial PVI. The P-SAECG was recorded before and after within 1 week the initial PVI session. The ltered P-wave duration FPD and root mean square voltage of the last 20 ms of the filtered P-wave LP20 were measured in 87 consecutive idiopathic AF patients ejection fraction ≥ 50 , B-type natriuretic peptide ≤ 200 pg / ml . During the follow-up period 12 7 months , 22 of 87 25 patients had recurrence of AF 11 with paroxysmal AF and 11 with persistent AF . In the group with recurrence of paroxysmal AF, the post-PVI FPD was signi cantly shorter and the post-PVI LP20 was signi cantly larger than in the non-recurrence group. Furthermore, the post-PVI LP20 / FPD ratio was signi cantly higher in the group with paroxysmal AF recurrence than in the nonrecurrence group 0.024 0.009 vs 0.015 0.007 µV / ms, respectively ; P 0.05 . Recurrence of paroxysmal AF was more frequently observed in patients with a post-PVI LP20 / FPD 0.015 µV / ms than in those with a post-PVI LP20 / FPD ≤ 0.015 µV / ms. The optimal post-PVI LP20 / FPD cut-off value of 0.015 µV / ms had a sensitivity of 90 and a speci city of 60 . The data also suggest that the post-PVI LP20 / FPD may be a new parameter for predicting successful PVI in patients with idiopathic paroxysmal AF after PVI.

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Value of P-wave signal averaging to predict atrial fibrillation recurrences after pulmonary vein isolation

Abstract: A FPD >140 ms is a marker of AF recurrences after RFCA and probably reflects the extent of atrial remodelling.

Cited by 51 publications

References 33 publications

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

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

Wavelet Entropy Automatically Detects Episodes of Atrial Fibrillation from Single-Lead Electrocardiograms

New Parameter to Predict Recurrence of Paroxysmal Atrial Fibrillation after Pulmonary Vein Isolation by the P-Wave Signal-Averaged Electrocardiogram

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