Key result
Cryoballoon PVI links to a ~15% decrease in P-wave terminal force and complexity versus baseline.
Why the study?
Cryoballoon ablation of AF alters a significant amount of myocardium, but the effect of pulmonary vein isolation on the P-wave remains unclear.
Does cryoballoon pulmonary vein isolation acutely alter signal-averaged P-wave parameters in patients with atrial fibrillation?
Observational (n=69)
Does cryoballoon pulmonary vein isolation acutely alter signal-averaged P-wave parameters in patients with atrial fibrillation?
Absolute Event Rate: 2.63% vs 3.08%
p-value: p=0.003
Cryoballoon pulmonary vein isolation acutely decreases P-wave terminal force, complexity, and sample entropy, suggesting high-resolution ECG can detect stepwise changes in atrial electrical activity during ablation.
Supports high-resolution ECG for detecting acute electrical changes during PVI; leaves open impact on clinical outcomes.
Background and aims Cryoballoon ablation of atrial fibrillation alters a significant amount of vital myocardium contributing to its electrical activity. However, the effect of pulmonary vein isolation (PVI) on the P-wave is unclear. The study aimed to quantify P-wave changes following individual PVI using signal-averaged ECG analysis. Materials and methods Unfiltered high-resolution (2,000 samples/second) ECGs were obtained for 5 min pre- and post-isolation of each pulmonary vein in 69 participants using 12 standard and 10 additional leads optimized for atrial electrical activity detection. Signal-averaged ECGs were computed and analyzed using custom software in Matlab. This study was registered at ClinicalTrials.gov (Identifier: NCT06061120). Results Significant changes in ECG parameters were found. Following complete PVI, P-wave terminal force measured in lead V1 (3.08 ± 1.99 vs. 2.63 ± 1.76 mV*ms, p = 0.003), as well as P-wave complexity (2.05 ± 0.65 vs. 1.79 ± 0.51, p < 0.001) and sample entropy (0.210 ± 0.039 vs. 0.187 ± 0.028 au, p < 0.001), both averaged across all leads, decreased significantly. Ablation of the left pulmonary veins was associated with lower values in P-wave terminal force (3.07 ± 2.05 vs. 2.84 ± 1.88 mV*ms, p = 0.003), P-wave complexity (2.02 ± 0.64 vs. 1.90 ± 0.57, p = 0.003), and sample entropy (0.210 ± 0.039 vs. 0.197 ± 0.031 au, p < 0.001) after ablation. For ablation of the right pulmonary veins, a decline was observed in sample entropy (0.196 ± 0.031 vs. 0.190 ± 0.027 au, p = 0.046). Conclusion The observed changes in signal-averaged P-wave parameters during cryoballoon PVI may indicate acute intraprocedural effects on atrial electrophysiology. These exploratory findings suggest that high-resolution, non-invasive ECG recordings are capable to detect stepwise changes of electrical atrial activity, offering new perspectives for intraprocedural assessment of ablation effects.
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Fantazi et al. (2026) conducted an observational in Atrial fibrillation (n=69). Cryoballoon pulmonary vein isolation vs. Pre-isolation baseline was evaluated on P-wave terminal force in lead V1 (mV*ms) (p=0.003). Cryoballoon pulmonary vein isolation significantly decreased P-wave terminal force in lead V1 (3.08 vs. 2.63 mV*ms, p=0.003), P-wave complexity, and sample entropy compared to pre-isolation.
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