What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation (n=27). Intervention: Pulmonary vein isolation vs. Failed pulmonary vein isolation (AF recurrence). Primary outcome: Change in P-wave duration (p=<0.0001).

What does this research mean for the field?

Successful pulmonary vein isolation significantly reduces P-wave duration, which can serve as an indicator of procedural success and suggests that pulmonary vein muscle sleeves contribute to the terminal portion of the P-wave. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

July 27, 2007

Reduction of P‐Wave Duration and Successful Pulmonary Vein Isolation in Patients with Atrial Fibrillation

Q: What are the key findings of this study?

Successful pulmonary vein isolation significantly reduced P-wave duration from 161 +/- 7 msec to 151 +/- 8 msec (P<0.0001), whereas failed isolation resulted in no change.

Q: What does this research mean for the field?

Successful pulmonary vein isolation significantly reduces P-wave duration, which can serve as an indicator of procedural success and suggests that pulmonary vein muscle sleeves contribute to the terminal portion of the P-wave. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Successful pulmonary vein isolation significantly reduced P-wave duration from 161 +/- 7 msec to 151 +/- 8 msec (P<0.0001), whereas failed isolation resulted in no change.

Study Design

Type

Observational (n=27)

Structured PICO

Does successful pulmonary vein isolation reduce P-wave duration in patients with atrial fibrillation?

Population

27 patients with atrial fibrillation undergoing 31 pulmonary vein isolation procedures

Intervention

Pulmonary vein isolation

Comparator

Pre-ablation baseline and patients with failed PV isolation (AF recurrences)

Outcome

Change in P-wave duration measured by magnified surface ECG and P-wave signal-averaged ECGsurrogate

A significant shortening of P-wave duration on signal-averaged ECG can serve as a non-invasive indicator of successful pulmonary vein isolation in patients with atrial fibrillation.

Main Result

p-value: p=<0.0001

Abstract

INTRODUCTION: We hypothesize that successful pulmonary vein (PV) isolation can shorten the P-wave duration in patients with atrial fibrillation (AF). METHODS AND RESULTS: We recorded magnified surface electrocardiogram (ECG) and P-wave signal-averaged ECG using 12 electrode leads before and after 31 PV isolation procedures in 27 patients with AF. The patients were followed for 16 +/- 4 months. Repeat ablation studies documented failed PV isolation in seven patients with AF recurrences. At baseline, the maximal P-wave duration in patients without AF recurrence (161 +/- 7 msec) was slightly shorter than that in patients with AF recurrence (168 +/- 10 msec, P < 0.05). After ablation, patients without recurrence showed a significant reduction of P-wave duration from 161 +/- 7 msec to 151 +/- 8 msec (P < 0.0001). In contrast, no change of P-wave duration was noted in patients with recurrences. These findings were confirmed with signal averaged ECG of the P-waves. Three-dimensional (3-D) computer simulation using an atrial cell model showed that elimination of the muscle sleeves inside the PV resulted in a shortening of the P-wave duration and change of the terminal portion of the P-wave morphology. CONCLUSIONS: A significant shortening of P-wave duration by P-wave signal-averaged ECG can be used as an indicator for successful PV isolation. These findings suggest that activation of the PV muscle sleeves may be an important component of the terminal portion of the P-wave on surface ECG.

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