Key result
Catheter ablation effects on P-waves and coronary sinus local activation waves showed moderate to high concordance in duration only after normalization (50% to 89%, p<0.0210).
Why the study?
Atrial substrate alteration from catheter ablation is primarily assessed using P-waves, but how catheter ablation affects critical structures such as the coronary sinus remains unknown.
Does catheter ablation affect coronary sinus local activation waves similarly to P-waves in patients with paroxysmal atrial fibrillation?
Observational (n=29)
Does catheter ablation affect coronary sinus local activation waves similarly to P-waves in patients with paroxysmal atrial fibrillation?
Heart rate fluctuations mask the correlation between coronary sinus local activation waves and P-waves during catheter ablation, requiring normalization prior to analysis to reveal moderate to high concordance in duration.
Normalization unmasks moderate-high duration concordance post-ablation; leaves open CS waves as P-wave surrogates in paroxysmal AF.
Atrial substrate alteration due to catheter ablation (CA) of atrial fibrillation (AF) is primarily assessed from P-waves. Nonetheless, how CA affects critical structures is ignored. The aim of the current study is to investigate if CA effect on CS, the principal CA reference, is related to that observed from P-waves analysis. Five-minute lead II and bipolar CS recordings of 29 paroxysmal AF patients were obtained before, during and after CA. Duration, amplitude, area and heart-rate (HR) variability (HRV) features were calculated for P-waves and local activation waves (LAWs). Normalization mitigated the effect of HR fluctuations. Linear correlations between each P-wave and LAW were tested with linear regression (LR) and Pearson correlation (PC) and nonlinear correlations with cross-quadratic sample entropy (CQSE). Correlation between the CA effect on P-waves and LAWs was investigated with PC. Negligent statistical correlations were found by PC and LR for amplitude and area (−3.30%< corr < +18.36%, p < 0.0142). After normalization, correlation in duration increased from non-significant to significant and from low to moderate (up to 47.25%, p < 0.0001). CQSE values were from 0.6 to 1.2. The effect of CA on P-waves and LAWs duration showed a moderate/high concordance after normalization (from 50% to 89%, p < 0.0210) and a highly tuned HRV (> 90%, p < 0.0297). Apart from HRV, no significant correlations between CS LAWs and P-waves have been found. HR fluctuations mask any possible tuning and normalization should be applied prior to the analysis.
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Vraka et al. (2021) conducted an observational in Paroxysmal atrial fibrillation (n=29). Catheter ablation was evaluated on Correlation between catheter ablation effect on P-waves and coronary sinus local activation waves. Catheter ablation effects on P-waves and coronary sinus local activation waves showed moderate to high concordance in duration only after normalization (50% to 89%, p<0.0210).
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