Key result
Pulmonary vein isolation significantly decreased overall P-wave duration (-9.84%, p=0.0085) and left atrial depolarization time (-22.03%, p=0.0250), but not right atrial depolarization.
Why the study?
Standard PWD reflects whole-atria substrate alterations after PVI, but the left and right atria may be affected differently, potentially requiring distinct post-PVI management.
Does pulmonary vein isolation alter specific components of P-wave duration corresponding to left and right atrial depolarization in patients with paroxysmal atrial fibrillation?
Observational (n=29)
Does pulmonary vein isolation alter specific components of P-wave duration corresponding to left and right atrial depolarization in patients with paroxysmal atrial fibrillation?
Pulmonary vein isolation significantly shortens the left atrial component of the P-wave, suggesting that left atrial analysis is crucial for assessing substrate alteration post-ablation.
Supports targeted left atrial P-wave assessment post-PVI; hypothesis-generating and requires prospective validation before clinical adoption.
While P-wave duration (PWD) is primarily employed to observe the atrial substrate alterations after pulmonary vein isolation (PVI) on atrial fibrillation (AF) patients, the acquired information corresponds to the entire atria. Left (LA) and right atrium (RA), though, may be differently affected by PVI, implying the need for different after-PVI handling. In order to clarify this assumption, five-minute lead II recordings from 29 paroxysmal AF patients undergoing first-ever PVI were recruited before and after PVI. PWD was analyzed integrally and in parts, with the first part (PWD <inf xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">1</inf> ) from the onset to the peak corresponding to RA and the second part (PWD <inf xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</inf> ) to LA depolarization. Time from P-wave onset or offset to the R peak were also calculated (P <inf xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">on</inf> – R and P <inf xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">off</inf> – R, respectively). Normalization (N) to mitigate heart-rate effect was applied. Results before and after PVI were compared with Mann-Whitney U-test (MWU). Median values and variations due to PVI were calculated for all features and compared between PWD and the remaining features via Pearson correlation. After PVI, PWD (−9.84%, p = 0.0085, N: − 17.96%, p = 0.0442) and PWD <inf xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</inf> (−22.03%, p = 0.0250, N: − 27.77%, p = 0.0268) were significantly decreased. PWD <inf xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">1</inf> did not shorten significantly (up to −8.96%, p > 0.05 at either cases). PWD – PWD <inf xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">1</inf> (ρ > 74.5%, p < 0.0001) showed higher correlation than PWD – PWD <inf xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</inf> (ρ > 41.9%, p < 0.0001) in before and after PVI analysis but not for PVI-related variation (ρ <inf xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">PWD-PWD</inf> <inf xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">1</inf> = 54.0%, p = 0.0114 and ρ <inf xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">PWD-PWD</inf> <inf xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</inf> = 61.4%, p = 0.0031). While RA depolarization time is more in line with PWD analysis, the effect of PVI in PWD is more coherent with LA’s findings. Additionally, PWD shortening is only observed in the LA. Therefore, LA is crucial for the assessment of the atrial substrate alteration after PVI and its analysis should be considered by future studies.
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Vraka et al. (2021) conducted an observational in Paroxysmal atrial fibrillation (n=29). Pulmonary vein isolation (PVI) vs. Before PVI was evaluated on P-wave duration (PWD) and its components (PWD1, PWD2) (p=0.0085). Pulmonary vein isolation significantly decreased overall P-wave duration (-9.84%, p=0.0085) and left atrial depolarization time (-22.03%, p=0.0250), but not right atrial depolarization.
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