Key result
Increased P-wave duration and amplitude post-PVI are linked to ~150% higher 12-month ablation failure risk.
Why the study?
Pulmonary vein isolation is a primary treatment for PAF, but the correlation between post-PVI P-wave parameters and ablation outcomes needed evaluation.
Do changes in P-wave parameters after pulmonary vein isolation predict ablation outcomes in patients with paroxysmal atrial fibrillation?
Cohort (n=180)
No
Do changes in P-wave parameters after pulmonary vein isolation predict ablation outcomes in patients with paroxysmal atrial fibrillation?
Effect estimate: HR 2.5 (95% CI 1.4-4.2)
p-value: p=<0.001
Increases in corrected P-wave duration and P-wave amplitude following pulmonary vein isolation are independent predictors of ablation failure at 12 months in patients with paroxysmal atrial fibrillation.
P-wave changes after PVI may flag higher failure risk in paroxysmal AF; leaves open prospective validation before guiding decisions.
BACKGROUND: Pulmonary vein isolation (PVI) is the most promising management method for paroxysmal atrial fibrillation (PAF). The P wave in the electrocardiogram (ECG) represents atrial depolarization. This study aims to correlate P-wave parameters after PVI with outcomes. METHODS: This single-center retrospective study included consecutive patients with first-time PVI for PAF between 2018 and 2019 and targeted pulmonary veins (PVs). Procedure success was defined by freedom of ECG-documented AF at 12 months. Digital 12 leads ECGs with 1-50 hertz bandpass filter were monitored before the procedure. P-wave amplitude (PWA) and P-wave terminal force in V1 (PTFV1) Corrected P-wave duration (PWDc), and P-wave dispersion (PWDisp), were measured before and after ablation. RESULTS: The final analysis included 180 patients, of which 130 (72%) had successful ablations and 53 (30%) had radiofrequency ablation (RF). Males comprised 71% of the patients; the mean age was 60. Demographics were similar between both arms p < 0.001. Patients with failed PVI had increased PWDc after PVI (139-146 ms, p < 0.001) compared to patients with successful PVI. PWA increased significantly after failed PVI (1.6-2 mV, p < 0.001) and successful PVI (1.6-1.8 mV, p = 0.008). PWD (hazard ratio [HR]: 2.5, 95% confidence interval [CI]: 1.4-4.2, p < 0.001) and PWA (HR: 1.7, 95% CI: 1.2-2.9, p = 0.03) were independently associated with PVI failure at 12 months. PWdisp and PTFV1 were not correlated with outcomes. CONCLUSION: Increased PWDc and PWA after PVI were independently associated with failed ablation for PAF, supporting the role of P-wave parameters in predicting outcomes.
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Antoun et al. (2024) conducted a cohort in Paroxysmal Atrial Fibrillation (n=180). P-wave parameters (PWDc and PWA) was evaluated on PVI failure at 12 months (HR 2.5, 95% CI 1.4-4.2, p=<0.001). Increased corrected P-wave duration (HR 2.5; 95% CI 1.4-4.2; p<0.001) and P-wave amplitude after pulmonary vein isolation were independently associated with ablation failure at 12 months.
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