Key result
Reduced PTFV1 after a second AF ablation correlates with 12-month freedom from AF.
Why the study?
Pulmonary vein isolation is effective for symptomatic paroxysmal AF, but the role of 12-lead ECG P-wave parameters in predicting the success of repeat ablation required investigation.
Do changes in P-wave parameters predict freedom from atrial fibrillation at 12 months in patients undergoing repeat catheter ablation for paroxysmal atrial fibrillation?
Cohort (n=72)
No
Do changes in P-wave parameters predict freedom from atrial fibrillation at 12 months in patients undergoing repeat catheter ablation for paroxysmal atrial fibrillation?
A reduction in P-wave terminal force in V1 (PTFV1) following a second catheter ablation for paroxysmal atrial fibrillation is associated with procedural success and freedom from AF at 12 months.
Answers are grounded in this paper and cite their sources.
PTFV1 reduction may indicate repeat ablation success in paroxysmal AF; hypothesis-generating and requires prospective validation.
BACKGROUND: Pulmonary vein isolation (PVI) has been established as an effective management option for symptomatic paroxysmal atrial fibrillation (PAF). We aimed to explore the role of P-wave parameters in a 12-lead electrocardiogram (ECG) in predicting the success of repeat PAF ablation. METHODS: We enrolled consecutive patients who underwent a second AF ablation procedure for PAF in a UK tertiary center after an index ablation conducted between 2018 and 2019 and a repeat ablation up to 2021. A digital 12-lead ECG was recorded with a 1-50-Hz bandpass filter applied. P-wave duration (PWD), P-wave voltage (PWV), P-wave dispersion (PWDisp), and P-wave terminal force in V1 (PTFV1) were measured before and after the procedure. Changes were correlated with the 12-month clinical outcome. Procedural success was freedom from ECG-documented AF up to 12 months following ablation. RESULTS: Study criteria were satisfied by 72 patients, of which 43 (60%) had successful repeat PVI at 12 months. The mean age is 65, and 47 (65%) were males. The demographics were comparable between both study arms. PWD decreased after successful repeat ablations (136.7 to 124.6 ms, p = 0.01) and failed repeat ablations (135.4 to 125.3 ms, p = 0.009) without a significant change between both arms. PMV and PWDisp did not change significantly after both study arms. PTFV1 significantly decreased after successful repeat ablations (-3.1 to -4.4 mm.s, p = 0.005) without a significant change after failed ablations (-2.9 to -2.7 mm.s, p = 0.42). Changes were statistically significant between both arms (p = 0.004). CONCLUSION: PTFV1 reduction following the second AF ablation was correlated with successful repeat AF ablation at 12 months.
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Antoun et al. (2024) conducted a cohort in Paroxysmal Atrial Fibrillation (n=72). Repeat catheter ablation was evaluated on Freedom from ECG-documented AF up to 12 months following ablation. Reduction in P-wave terminal force in V1 (PTFV1) following a second ablation for paroxysmal atrial fibrillation correlated with successful repeat ablation at 12 months (p=0.004 between groups).
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