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Published in: Journal of Interventional Cardiac Electrophysiology 2/2014

01-03-2014

Prolonged P-wave duration is associated with atrial fibrillation recurrence after successful pulmonary vein isolation for paroxysmal atrial fibrillation

Authors: Jane Caldwell, Sahil Koppikar, Walid Barake, Damian Redfearn, Kevin Michael, Christopher Simpson, Wilma Hopman, Adrian Baranchuk

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 2/2014

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Abstract

Pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) is successful in ∼70–80 % after repeated procedures. This suggests a subgroup of PAF patients where electrical abnormalities outside the pulmonary veins are important. Prolonged P-wave duration (PWD), a marker of atrial remodelling, may identify this subgroup. This study’s aim was to assess the association of PWD on standard 12 lead ECG with AF recurrence post PVI.

Methods

Retrospectively, ECGs were blindly analysed on PVI patients from August 2007–August 2011; patients with persistent AF, mitral valve disease, undergoing redo procedures or no sinus rhythm (SR) ECG within 1 year of PVI were excluded. ECGs were directly uploaded at 300 dpi, amplified ×10, and then PWD measured in all leads. Prolonged PWD was as priori defined as maximum PWD ≥ 140 ms.

Results

The selective cohort consisted of 100 patients out of a total of 170 PVI: age 58 ± 11 years, 72 % male, LVEF 62 ± 9 %, 18 % ischaemic heart disease and 13 % diabetic. Thirty-five had prolonged PWD, which was associated with greater AF recurrence rates compared to those without prolonged PWD (63 vs. 38 %, p < 0.05). Similarly, AF recurrence was associated with greater maximum PWD (139 ± 17 vs. 129 ± 14, p < 0.01), P-wave dispersion (58 ± 21 vs. 49 ± 15, p < 0.01), left atrium (LA) dimension (41 ± 6 vs. 38 ± 5, p < 0.05) and LA volumes (40 ± 14 vs. 34 ± 11, p < 0.05) compared to those who remained in SR. None of these variables were independent predictors of AF recurrence by multivariate analysis.

Conclusion

The presence of pre-existent prolonged PWD is associated with a higher risk of AF recurrence post PVI for paroxysmal AF.
Literature
1.
go back to reference Calkins, H., Kuck, K. H., Cappato, R., Brugada, J., Camm, A. J., Chen, S. A., et al. (2012). HRS/EHRA/ECAS Expert consensus statement on catheter and surgical ablation of atrial fibrillation: Recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Journal of Interventional Cardiac Electrophysiology, 33, 171–257.PubMedCrossRef Calkins, H., Kuck, K. H., Cappato, R., Brugada, J., Camm, A. J., Chen, S. A., et al. (2012). HRS/EHRA/ECAS Expert consensus statement on catheter and surgical ablation of atrial fibrillation: Recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Journal of Interventional Cardiac Electrophysiology, 33, 171–257.PubMedCrossRef
2.
go back to reference Medi, C., Sparks, P. B., Morton, J. B., Kistler, P. M., Halloran, K., Rosso, R., et al. (2011). Pulmonary vein antral isolation for paroxysmal atrial fibrillation: results from long-term follow-up. Journal of Cardiovascular Electrophysiology, 22(2), 137–141.PubMed Medi, C., Sparks, P. B., Morton, J. B., Kistler, P. M., Halloran, K., Rosso, R., et al. (2011). Pulmonary vein antral isolation for paroxysmal atrial fibrillation: results from long-term follow-up. Journal of Cardiovascular Electrophysiology, 22(2), 137–141.PubMed
3.
go back to reference Callans, D. J., Gerstenfeld, E. P., Dixit, S., Zado, E., Vanaderhoff, M., et al. (2004). Efficacy of repeat pulmonary vein isolation procedures in patients with recurrent atrial fibrillation. Journal of Cardiovascular Electrophysiology, 15(9), 1050–1055.PubMedCrossRef Callans, D. J., Gerstenfeld, E. P., Dixit, S., Zado, E., Vanaderhoff, M., et al. (2004). Efficacy of repeat pulmonary vein isolation procedures in patients with recurrent atrial fibrillation. Journal of Cardiovascular Electrophysiology, 15(9), 1050–1055.PubMedCrossRef
4.
go back to reference Gerstenfeld, E. P., Callans, D. J., Dixit, S., Zado, E., & Marchlinski, F. E. (2003). Incidence and location of focal atrial fibrillation triggers in patients undergoing repeat pulmonary vein isolation. Journal of Cardiovascular Electrophysiology, 14(7), 685–690.PubMedCrossRef Gerstenfeld, E. P., Callans, D. J., Dixit, S., Zado, E., & Marchlinski, F. E. (2003). Incidence and location of focal atrial fibrillation triggers in patients undergoing repeat pulmonary vein isolation. Journal of Cardiovascular Electrophysiology, 14(7), 685–690.PubMedCrossRef
5.
go back to reference Brooks, A. G., Stiles, M. K., Laborderie, J., Lau, D. H., Kuklik, P., Shipp, N. J., et al. (2010). Outcomes of long-standing persistent atrial fibrillation ablation: a systematic review. Heart Rhythm, 7(6), 835–846.PubMedCrossRef Brooks, A. G., Stiles, M. K., Laborderie, J., Lau, D. H., Kuklik, P., Shipp, N. J., et al. (2010). Outcomes of long-standing persistent atrial fibrillation ablation: a systematic review. Heart Rhythm, 7(6), 835–846.PubMedCrossRef
6.
go back to reference Redfearn, D. P., Lane, J., Ward, K., & Stafford, P. J. (2006). High-resolution analysis of the surface P wave as a measure of atrial electrophysiological substrate. Annals of Noninvasive Electrocardiology, 11(1), 12–19.PubMedCrossRef Redfearn, D. P., Lane, J., Ward, K., & Stafford, P. J. (2006). High-resolution analysis of the surface P wave as a measure of atrial electrophysiological substrate. Annals of Noninvasive Electrocardiology, 11(1), 12–19.PubMedCrossRef
7.
go back to reference de Luna, B., Cladellas, M., Oter, R., Torner, P., Guindo, J., Marti, V., et al. (1988). Interatrial conduction block and retrograde activation of the left atrium and paroxysmal supraventricular tachyarrhythmia. European Heart Journal, 9(10), 1112–1118. de Luna, B., Cladellas, M., Oter, R., Torner, P., Guindo, J., Marti, V., et al. (1988). Interatrial conduction block and retrograde activation of the left atrium and paroxysmal supraventricular tachyarrhythmia. European Heart Journal, 9(10), 1112–1118.
8.
go back to reference Agarwal, Y. K., Aronow, W. S., Levy, J. A., & Spodick, D. H. (2003). Association of interatrial block with development of atrial fibrillation. American Journal of Cardiology, 91(7), 882.PubMedCrossRef Agarwal, Y. K., Aronow, W. S., Levy, J. A., & Spodick, D. H. (2003). Association of interatrial block with development of atrial fibrillation. American Journal of Cardiology, 91(7), 882.PubMedCrossRef
9.
go back to reference Ariyarajah, V., Apiyasawat, S., Fernandes, J., Kranis, M., & Spodick, D. H. (2007). Association of atrial fibrillation in patients with interatrial block over prospectively followed controls with comparable echocardiographic parameters. American Journal of Cardiology, 99(3), 390–392.PubMedCrossRef Ariyarajah, V., Apiyasawat, S., Fernandes, J., Kranis, M., & Spodick, D. H. (2007). Association of atrial fibrillation in patients with interatrial block over prospectively followed controls with comparable echocardiographic parameters. American Journal of Cardiology, 99(3), 390–392.PubMedCrossRef
10.
go back to reference Magnani, J. W., Johnson, V. M., Sullivan, L. M., Gorodeski, E. Z., Schnabel, R. B., Lubitz, S. A., et al. (2011). P wave duration and risk of longitudinal atrial fibrillation in persons >60 years old (from the Framingham Heart Study). The American Journal of Cardiology, 107(6), 917–921.PubMedCentralPubMedCrossRef Magnani, J. W., Johnson, V. M., Sullivan, L. M., Gorodeski, E. Z., Schnabel, R. B., Lubitz, S. A., et al. (2011). P wave duration and risk of longitudinal atrial fibrillation in persons >60 years old (from the Framingham Heart Study). The American Journal of Cardiology, 107(6), 917–921.PubMedCentralPubMedCrossRef
11.
go back to reference Budeus, M., Hennersdorf, M., Perings, C., Wieneke, H., Erbel, R., & Sack, S. (2005). Prediction of the recurrence of atrial fibrillation after successful cardioversion with P wave signal-averaged ECG. Annals of Noninvasive Electrocardiology, 10(4), 414–419.PubMedCrossRef Budeus, M., Hennersdorf, M., Perings, C., Wieneke, H., Erbel, R., & Sack, S. (2005). Prediction of the recurrence of atrial fibrillation after successful cardioversion with P wave signal-averaged ECG. Annals of Noninvasive Electrocardiology, 10(4), 414–419.PubMedCrossRef
12.
go back to reference Koide, Y., Yotsukura, M., Ando, H., Aoki, S., Suzuki, T., Sakata, K., et al. (2008). Usefulness of P-wave dispersion in standard twelve-lead electrocardiography to predict transition from paroxysmal to persistent atrial fibrillation. The American Journal of Cardiology, 102(5), 573–577.PubMedCrossRef Koide, Y., Yotsukura, M., Ando, H., Aoki, S., Suzuki, T., Sakata, K., et al. (2008). Usefulness of P-wave dispersion in standard twelve-lead electrocardiography to predict transition from paroxysmal to persistent atrial fibrillation. The American Journal of Cardiology, 102(5), 573–577.PubMedCrossRef
13.
go back to reference Dixen, U., Vang Larsen, M., Ravn, L., Parner, J., & Jensen, G. B. (2008). Signal-averaged P wave duration and the long-term risk of permanent atrial fibrillation. Scandinavian Cardiovascular Journal, 42(1), 31–37.PubMedCrossRef Dixen, U., Vang Larsen, M., Ravn, L., Parner, J., & Jensen, G. B. (2008). Signal-averaged P wave duration and the long-term risk of permanent atrial fibrillation. Scandinavian Cardiovascular Journal, 42(1), 31–37.PubMedCrossRef
14.
go back to reference de Bayes, L. A., Platonov, P., Cosio, F. G., Cygankiewicz, I., Pastore, C., Baranowski, R., et al. (2012). Interatrial blocks. A separate entity from left atrial enlargement: a consensus report. Journal of Electrocardiology, 45(5), 445–451.CrossRef de Bayes, L. A., Platonov, P., Cosio, F. G., Cygankiewicz, I., Pastore, C., Baranowski, R., et al. (2012). Interatrial blocks. A separate entity from left atrial enlargement: a consensus report. Journal of Electrocardiology, 45(5), 445–451.CrossRef
15.
go back to reference Berruezo, A., Tamborero, D., Mont, L., Benito, B., Tolosana, J. M., Sitges, M., et al. (2007). Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation. European Heart Journal, 28(7), 836–841.PubMedCrossRef Berruezo, A., Tamborero, D., Mont, L., Benito, B., Tolosana, J. M., Sitges, M., et al. (2007). Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation. European Heart Journal, 28(7), 836–841.PubMedCrossRef
16.
go back to reference den Uijl, D. W., Delgado, V., Bertini, M., Tops, L. F., Trines, S. A., van de Veire, N. R., et al. (2011). Impact of left atrial fibrosis and left atrial size on the outcome of catheter ablation for atrial fibrillation. Heart, 97(22), 1847–1851.CrossRef den Uijl, D. W., Delgado, V., Bertini, M., Tops, L. F., Trines, S. A., van de Veire, N. R., et al. (2011). Impact of left atrial fibrosis and left atrial size on the outcome of catheter ablation for atrial fibrillation. Heart, 97(22), 1847–1851.CrossRef
17.
go back to reference Sohns, C., Sohns, J. M., Vollmann, D., Luthje, L., Bergau, L., Dorenkamp, M., et al. (2013). Left atrial volumetry from routine diagnostic work up prior to pulmonary vein ablation is a good predictor of freedom from atrial fibrillation. European Heart Journal of Cardiovascular Imaging, 14(7), 684–691.CrossRef Sohns, C., Sohns, J. M., Vollmann, D., Luthje, L., Bergau, L., Dorenkamp, M., et al. (2013). Left atrial volumetry from routine diagnostic work up prior to pulmonary vein ablation is a good predictor of freedom from atrial fibrillation. European Heart Journal of Cardiovascular Imaging, 14(7), 684–691.CrossRef
18.
go back to reference den Uijl, D. W., Tops, L. F., Delgado, V., Schuijf, J. D., Kroft, L. J. M., de Roos, A., et al. (2011). Effect of pulmonary vein anatomy and left atrial dimensions on outcome of circumferential radiofrequency catheter ablation for atrial fibrillation. The American Journal of Cardiology, 107(2), 243–249. den Uijl, D. W., Tops, L. F., Delgado, V., Schuijf, J. D., Kroft, L. J. M., de Roos, A., et al. (2011). Effect of pulmonary vein anatomy and left atrial dimensions on outcome of circumferential radiofrequency catheter ablation for atrial fibrillation. The American Journal of Cardiology, 107(2), 243–249.
19.
go back to reference Parikh, S. S., Jons, C., McNitt, S., Daubert, J. P., Schwarz, K. Q., & Hall, B. (2010). Predictive capability of left atrial size measured by CT, TEE, and TTE for recurrence of atrial fibrillation following radiofrequency catheter ablation. Pacing and Clinical Electrophysiology, 33(5), 532–540.PubMedCrossRef Parikh, S. S., Jons, C., McNitt, S., Daubert, J. P., Schwarz, K. Q., & Hall, B. (2010). Predictive capability of left atrial size measured by CT, TEE, and TTE for recurrence of atrial fibrillation following radiofrequency catheter ablation. Pacing and Clinical Electrophysiology, 33(5), 532–540.PubMedCrossRef
20.
go back to reference Blanche, C., Tran, N., Rigamonti, F., Burri, H., & Zimmermann, M. (2013). Value of P-wave signal averaging to predict atrial fibrillation recurrences after pulmonary vein isolation. Europace, 15(2), 198–204.PubMedCrossRef Blanche, C., Tran, N., Rigamonti, F., Burri, H., & Zimmermann, M. (2013). Value of P-wave signal averaging to predict atrial fibrillation recurrences after pulmonary vein isolation. Europace, 15(2), 198–204.PubMedCrossRef
21.
go back to reference Okumura, Y., Watanabe, I., Ohkubo, K., Ashino, S., Kofune, M., Hashimoto, K., et al. (2007). Prediction of the efficacy of pulmonary vein isolation for the treatment of atrial fibrillation by the signal-averaged P-wave duration. Pacing and Clinical Electrophysiology, 30(3), 304–313.PubMedCrossRef Okumura, Y., Watanabe, I., Ohkubo, K., Ashino, S., Kofune, M., Hashimoto, K., et al. (2007). Prediction of the efficacy of pulmonary vein isolation for the treatment of atrial fibrillation by the signal-averaged P-wave duration. Pacing and Clinical Electrophysiology, 30(3), 304–313.PubMedCrossRef
22.
go back to reference Ogawa, M., Kumagai, K., Vakulenko, M., Yasuda, T., Siegerman, C., Garfinkel, A., et al. (2007). Reduction of P-wave duration and successful pulmonary vein isolation in patients with atrial fibrillation. Journal of Cardiovascular Electrophysiology, 18(9), 931–938.PubMedCrossRef Ogawa, M., Kumagai, K., Vakulenko, M., Yasuda, T., Siegerman, C., Garfinkel, A., et al. (2007). Reduction of P-wave duration and successful pulmonary vein isolation in patients with atrial fibrillation. Journal of Cardiovascular Electrophysiology, 18(9), 931–938.PubMedCrossRef
23.
go back to reference Baranchuk, A., Pang, H., Seaborn, G., Yazdan-Ashoori, P., Redfearn, D. P., Simpson, C. S., et al. (2013). Reverse atrial electrical remodelling induced by continuous positive airway pressure in patients with severe obstructive sleep apnoea. Journal of Interventional Cardiac Electrophysiology, 36(3), 247–253.PubMedCrossRef Baranchuk, A., Pang, H., Seaborn, G., Yazdan-Ashoori, P., Redfearn, D. P., Simpson, C. S., et al. (2013). Reverse atrial electrical remodelling induced by continuous positive airway pressure in patients with severe obstructive sleep apnoea. Journal of Interventional Cardiac Electrophysiology, 36(3), 247–253.PubMedCrossRef
Metadata
Title
Prolonged P-wave duration is associated with atrial fibrillation recurrence after successful pulmonary vein isolation for paroxysmal atrial fibrillation
Authors
Jane Caldwell
Sahil Koppikar
Walid Barake
Damian Redfearn
Kevin Michael
Christopher Simpson
Wilma Hopman
Adrian Baranchuk
Publication date
01-03-2014
Publisher
Springer US
Published in
Journal of Interventional Cardiac Electrophysiology / Issue 2/2014
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI
https://doi.org/10.1007/s10840-013-9851-1

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