Electrocardiogram characteristics of P wave associated with successful pulmonary vein isolation in patients with paroxysmal atrial fibrillation: Significance of changes in P‐wave duration and notched P wave

Figures

• 

  Figure 1. Flowchart of the study design. AF, atrial fibrillation; ECG, electrocardiogram; PV, pulmonary vein

• 

  Figure 2. Changes in electrocardiogram parameters between the initial and repeat procedures. *p < .05 baseline versus just after the procedure. †p < .05 just after the procedure versus repeat procedure. ‡p < .05 baseline versus repeat procedure. PV, pulmonary vein; PWD, P‐wave duration. Note that the follow‐up ECG and signal‐averaged ECG analyses in the validation cohort group were obtained 6 and 1 month after the first ablation, respectively

• 

  Figure 3. Changes in P‐wave morphology on the electrocardiogram following ablation in patients without PV reconnection at the time of repeat procedure. In case 1, second peak of the P wave after a notch presented at the V2 through V6 lead on initial ablation. At the repeat procedure, these second portions of the P wave including the notch were absent. Similarly, in case 2, a discrete second part of P wave after a notch was identified in the V2‐V6 leads at baseline, and then, these later portions of the P wave and notch disappeared at the time of repeat session. PV, pulmonary vein

• 

  Figure 4. Changes in P‐wave morphology on the electrocardiogram following ablation and intracardiac electrogram at the repeat procedure in a patient presenting all 4 PVs reconnection. (a) In case 9, the 12‐lead surface electrocardiogram at the initial ablation demonstrated the presence of a second portion of P wave after a notch in the inferior leads. In the repeat procedure, the electrocardiogram showed a new notched P wave in the V2‐4 leads. In addition, the second part of the P wave at the inferior leads at the baseline showed a delay. (b) On the intracardiac electrogram at the time of the repeat procedure in the same patient, the potential of the LS and RSPVs recorded in the circular mapping catheter positioned at the PV‐LA junction resulted to be on a significant delay (152 and 157 ms, respectively) from the beginning of P wave (white arrow). Notably, the AF occurred from the LSPV (black arrow), but the LA including the LIPV presented a slow regular atrial tachycardia indicating a conduction delay between the LSPV and LA (*). CS, coronary sinus; LA, left atrium; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; PV, pulmonary vein; RIPV, right inferior pulmonary…