Variation of P-wave indices in paroxysmal atrial fibrillation patients before and after catheter ablation

Ortigosa, Nuria; Ayala, Guillermo; Cano, Óscar

doi:10.1016/j.bspc.2021.102500

Cited by 5 publications

(4 citation statements)

References 53 publications

(62 reference statements)

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“…Moreover, there is direct correlation between the increment of λ 1 and the decrement of ρ (Equation (1)). The increment of λ 1 is in line with obtained results in previous studies that showed an increment of P-wave amplitudes and P-wave areas after PVI in ECG recordings [12,13] and simulations [34,35].…”

Section: Discussionsupporting

confidence: 91%

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Characterization of Changes in P-Wave VCG Loops Following Pulmonary-Vein Isolation

Ortigosa

Cano

Sandberg

2021

Sensors

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Atrial fibrillation is the most common type of cardiac arrhythmia in clinical practice. Currently, catheter ablation for pulmonary-vein isolation is a well-established treatment for maintaining sinus rhythm when antiarrhythmic drugs do not succeed. Unfortunately, arrhythmia recurrence after catheter ablation remains common, with estimated rates of up to 45%. A better understanding of factors leading to atrial-fibrillation recurrence is needed. Hence, the aim of this study is to characterize changes in the atrial propagation pattern following pulmonary-vein isolation, and investigate the relation between such characteristics and atrial-fibrillation recurrence. Fifty patients with paroxysmal atrial fibrillation who had undergone catheter ablation were included in this study. Time-segment and vectorcardiogram-loop-morphology analyses were applied to characterize P waves extracted from 1 min long 12-lead electrocardiogram segments before and after the procedure, respectively. Results showed that P-wave vectorcardiogram loops were significantly less round and more planar, P waves and PR intervals were significantly shorter, and heart rate was significantly higher after the procedure. Differences were larger for patients who did not have arrhythmia recurrences at 2 years of follow-up; for these patients, the pre- and postprocedure P waves could be identified with 84% accuracy.

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Section: Discussionsupporting

confidence: 91%

“…Some studies focused on the spectral content of F waves, of which the dominant frequency was found to significantly decrease during catheter ablation [9], and their related spectral features are useful in predicting the procedure outcome [10]. Further, a decrease in P-wave area is associated with AF recurrence [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Characterization of Changes in P-Wave VCG Loops Following Pulmonary-Vein Isolation

Ortigosa

Cano

Sandberg

2021

Sensors

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“…Exposure to RF energy, not only affecting ARV but also MV may be an explanation. Recently a study found MV in lead V1 P-waves of paroxysmal AF undergoing CA of PVs to decrease after the procedure, as a sign of a successful ablation [ 78 ]. Apart from the fact that these results come from P-waves analysis, which in our case show a slight attenuation overall, MV in the present analysis was extracted by a template of the 20 most similar activations and not by considering all activations of one recording.…”

Section: Discussionmentioning

confidence: 99%

The Dissimilar Impact in Atrial Substrate Modificationof Left and Right Pulmonary Veins Isolation after Catheter Ablation of Paroxysmal Atrial Fibrillation

Vraka

Bertomeu-González

Fácila

et al. 2022

JPM

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Since the discovery of pulmonary veins (PVs) as foci of atrial fibrillation (AF), the commonest cardiac arrhythmia, investigation revolves around PVs catheter ablation (CA) results. Notwithstanding, CA process itself is rather neglected. We aim to decompose crucial CA steps: coronary sinus (CS) catheterization and the impact of left and right PVs isolation (LPVI, RPVI), separately. We recruited 40 paroxysmal AF patients undergoing first-time CA and obtained five-minute lead II and bipolar CS recordings during sinus rhythm (SR) before CA (B), after LPVI (L) and after RPVI (R). Among others, duration, amplitude and atrial-rate variability (ARV) were calculated for P-waves and CS local activation waves (LAWs). LAWs features were compared among CS channels for reliability analysis. P-waves and LAWs features were compared after each ablation step (B, L, R). CS channels: amplitude and area were different between distal/medial (p≤0.0014) and distal/mid-proximal channels (p≤0.0025). Medial and distal showed the most and least coherent values, respectively. Correlation was higher in proximal (≥93%) than distal (≤91%) areas. P-waves: duration was significantly shortened after LPVI (after L: p=0.0012, −13.30%). LAWs: insignificant variations. ARV modification was more prominent in LAWs (L: >+73.12%, p≤0.0480, R: <−33.94%, p≤0.0642). Medial/mid-proximal channels are recommended during SR. CS LAWs are not significantly affected by CA but they describe more precisely CA-induced ARV modifications. LPVI provokes the highest impact in paroxysmal AF CA, significantly modifying P-wave duration.

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“…Hence, P-wave variations after CA reflect changes in the atrial contractility. Many studies have revealed the capability of P-wave parameters such as P-wave duration, amplitude, as well as the frequency domain analysis of assessing the CA outcome [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. P-wave duration is probably the most relevant feature, as it measures the duration of the atrial depolarization [ 40 ].…”

Section: Introductionmentioning

confidence: 99%

The Relevance of Heart Rate Fluctuation When Evaluating Atrial Substrate Electrical Features in Catheter Ablation of Paroxysmal Atrial Fibrillation

Vraka

Moreno‐Arribas

Gracia-Baena

et al. 2022

JCDD

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Coronary sinus (CS) catheterization is critical during catheter ablation (CA) of atrial fibrillation (AF). However, the association of CS electrical activity with atrial substrate modification has been barely investigated and mostly limited to analyses during AF. In sinus rhythm (SR), atrial substrate modification is principally assessed at a global level through P-wave analysis. Cross-correlating CS electrograms (EGMs) and P-waves’ features could potentiate the understanding of AF mechanisms. Five-minute surface lead II and bipolar CS recordings before, during, and after CA were acquired from 40 paroxysmal AF patients. Features related to duration, amplitude, and heart-rate variability of atrial activations were evaluated. Heart-rate adjustment (HRA) was applied. Correlations between each P-wave and CS local activation wave (LAW) feature were computed with cross-quadratic sample entropy (CQSE), Pearson correlation (PC), and linear regression (LR) with 10-fold cross-validation. The effect of CA between different ablation steps was compared with PC. Linear correlations: poor to mediocre before HRA for analysis at each P-wave/LAW (PC: max. +18.36%, p=0.0017, LR: max. +5.33%, p=0.0002) and comparison between two ablation steps (max. +54.07%, p=0.0205). HRA significantly enhanced these relationships, especially in duration (P-wave/LAW: +43.82% to +69.91%, p<0.0001 for PC and +18.97% to +47.25%, p<0.0001 for LR, CA effect: +53.90% to +85.72%, p<0.0210). CQSE reported negligent correlations (0.6 –1.2). Direct analysis of CS features is unreliable to evaluate atrial substrate modification due to CA. HRA substantially solves this problem, potentiating correlation with P-wave features. Hence, its application is highly recommended.

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Variation of P-wave indices in paroxysmal atrial fibrillation patients before and after catheter ablation

Cited by 5 publications

References 53 publications

Characterization of Changes in P-Wave VCG Loops Following Pulmonary-Vein Isolation

Characterization of Changes in P-Wave VCG Loops Following Pulmonary-Vein Isolation

The Dissimilar Impact in Atrial Substrate Modificationof Left and Right Pulmonary Veins Isolation after Catheter Ablation of Paroxysmal Atrial Fibrillation

The Relevance of Heart Rate Fluctuation When Evaluating Atrial Substrate Electrical Features in Catheter Ablation of Paroxysmal Atrial Fibrillation

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