The Role of P Wave Parameters in Predicting Pulmonary Vein Isolation Outcomes for Paroxysmal Atrial Fibrillation: An Observational Cohort Study

• Published in: Journal of cardiovascular development and disease Vol. 11; no. 9; p. 277
• Main Authors: Antoun, Ibrahim, Li, Xin, Kotb, Ahmed I, Vali, Zakkariya, Abdelrazik, Ahmed, Koya, Abdulmalik, Mavilakandy, Akash, Koev, Ivelin, Nizam, Ali, Eldeeb, Hany, Somani, Riyaz, Ng, André
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 05-09-2024; MDPI
• Subjects: Ablation; Ablation (Surgery); Atrial fibrillation; Cardiac arrhythmia; Cardiomyopathy; catheter ablation; Catheters; Cohort analysis; Dementia; Ischemia; Morphology; P wave; P wave amplitude; P wave duration; Patients; Prognosis; Stroke; Veins & arteries; United Kingdom; United Kingdom > UK; United States > US; P wave amplitude; atrial fibrillation; catheter ablation; P wave duration; P wave
• ISSN: 2308-3425; 2308-3425
• DOI: 10.3390/jcdd11090277

Pulmonary vein isolation (PVI) is an effective management method for paroxysmal atrial fibrillation (PAF). The P wave in the 12-lead electrocardiogram (ECG) represents atrial depolarisation. This study aims to utilise the P wave to predict PVI outcomes for PAF.
This single-centre retrospective study aimed to predict PVI outcomes using P wave parameters. It included 211 consecutive patients with first PVI for PAF between 2018 and 2019 and targeted the pulmonary veins (PVs). Procedure success was defined by freedom of ECG-documented AF at 12 months. Digital 12-lead ECGs with 1-50 hertz bandpass filters were monitored before the procedure. Corrected P wave duration (PWDc), P wave amplitude (PWV), P wave dispersion (PWDisp), intra-atrial block (IAB), P wave area (PWA), and P wave terminal force in V1 (PTFV1) were measured before ablation and correlated with the outcomes.
Successful PVI occurred in 154 patients (73%). Demographics were similar between both arms. P wave parameters correlated with PVI failure included increased PWDc in all leads except for lead III, aVR, and V3, decreased PWV in lead I (hazard ratio [HR]: 0.7, 95% confidence interval [CI]: 0.53-0.95), lead II (HR: 0.45, 95% CI: 0.22-0.65), aVL (HR: 0.58, 95% CI: 0.22-0.98), and aVF (HR: 0.67, 95% CI: 0.58-0.87), decreased PWA in lead I (HR: 0.55, 95% CI: 0.21-0.76), lead II (HR: 0.48, 95% CI: 0.34-0.87), aVL (HR: 0.65, 95% CI: 0.45-0.96), and aVF (HR: 0.61, 95% CI: 0.32-0.89), and the presence of IAB (HR: 2, 95% CI: 1.4-4.2,
= 0.02). PWDisp and PTFV1 were not correlated with PVI outcome.
PWDc, PWA, PWV, and IAB are valuable predictors for PVI outcome for PAF at 12 months.