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

AbstractPulmonary vein isolation (PVI) for paroxysmal atrialfibrillation (PAF) is successful in ∼70–80 % after repeatedprocedures. This suggests a subgroup of PAF patients whereelectrical abnormalities outside the pulmonary veins areimportant. Prolonged P-wave duration (PWD), a marker ofatrial remodelling, may identify this subgroup. This study’saimwastoassesstheassociationofPWDonstandard12leadECG with AF recurrence post PVI.MethodsRetrospectively, ECGs were blindly analysed on PVI patientsfrom August 2007–August 2011; patients with persistent AF,mitral valve disease, undergoing redo procedures or no sinusrhythm(SR)ECGwithin1yearofPVIwereexcluded.ECGswere directly uploaded at 300 dpi, amplified ×10, and thenPWD measured in all leads. Prolonged PWD was as prioridefined as maximum PWD≥140 ms.ResultsThe selective cohort consisted of 100 patients out of a total of170 PVI: age 58±11 years, 72 % male, LVEF 62±9 %, 18 %ischaemic heart disease and 13 % diabetic. Thirty-five hadprolonged PWD, which was associated with greater AFrecurrence rates compared to those without prolonged PWD(63 vs. 38 %, p<0.05). Similarly, AF recurrence wasassociated with greater maximum PWD (139±17 vs. 129±14,p<0.01),P-wavedispersion(58±21vs.49±15,p<0.01),leftatrium(LA)dimension(41±6vs.38±5,p<0.05)andLAvolumes (40±14vs. 34±11, p<0.05) compared to those whoremained in SR. None of these variables were independentpredictors of AF recurrence by multivariate analysis.ConclusionThe presence of pre-existent prolonged PWD is associatedwith a higher risk of AF recurrence post PVI for paroxysmalAF.Keywords AtrialP-waveduration .Atrialfibrillation .Pulmonaryveinisolation .AFrecurrence1 IntroductionPulmonaryveinisolation(PVI)istherecommendedtreatmentfor symptomatic, drug refractoryparoxysmalatrialfibrillation(PAF) [1]. Its strategy, to electrically isolate aberrant ectopicactivity within the pulmonary veins (PV) from the left atrium(LA)has,atbest,asuccessrateof80%,oftenrequiringrepeatprocedures and/or the use of adjunctiveantiarrhythmic agents[2]. Whilst reconnection of the PVs is thought culprit for AFrecurrence, in some, full isolation remains despite AFrecurrence [3, 4]. This suggests that in a subgroup of PAFpatients, electrical abnormalities outside the PVs may beimportant.Inthissubgroup, the atrialtissuemay havealready