Key result
Patients with paroxysmal atrial fibrillation had longer total P-wave duration (140 vs 123 ms, p=0.004) and conduction delays than controls, but these did not predict AF recurrence after ablation.
Why the study?
Do electrophysiological parameters differ in patients with paroxysmal AF without structural heart disease compared to controls, and do they predict AF recurrence after ablation?
Case-Control (n=57)
Do electrophysiological parameters differ in patients with paroxysmal AF without structural heart disease compared to controls, and do they predict AF recurrence after ablation?
While patients with paroxysmal AF without structural heart disease exhibit significant atrial electrophysiological abnormalities compared to controls, these parameters do not predict arrhythmia recurrence after pulmonary vein isolation.
Answers are grounded in this paper and cite their sources.
P-wave parameters should not guide post-ablation recurrence prediction in paroxysmal AF; leaves open their role in mapping modifiable atrial substrate.
PURPOSE: The aim of the present study was to define the atrial electrical substrate in patients with paroxysmal atrial fibrillation (AF) occurring in the absence of overt structural heart disease and to assess if electrophysiological parameters could predict AF recurrence after radiofrequency ablation in this population. METHODS AND RESULTS: 45 consecutive patients (39 male, age 59 ± 10 years) with paroxysmal AF and without overt structural heart disease, referred for radiofrequency catheter ablation, were prospectively enrolled. A cohort of 12 age-matched patients without a history of AF, served as a control group. Atrial electrical substrate was assessed by P-wave signal-averaging, intracardiac conduction delays and refractory periods. Total P wave duration during signal-averaging was longer in patients with paroxysmal AF than in controls (140 ± 19 ms vs 123 ± 13 ms, p = 0.004). Patients with paroxysmal AF showed an increase in right intra-atrial (40.2 ± 11.3 ms vs 31.7 ± 11.8 ms, p = 0.02) and inter-atrial conduction delays (87.93 ± 22.0 ms vs 65.3 ± 15.6 ms, p = 0.001) in sinus rhythm. Refractory periods in the right atrium were longer in patients with paroxysmal AF (265 ± 44 ms vs 222 ± 32 ms, p = 0.002). After ablation, 22 patients had AF recurrence but showed no differences in electrophysiological parameters compared to patients without recurrence. CONCLUSION: Electrophysiological abnormalities are present in patients with paroxysmal AF without overt structural heart disease. Neither signal-averaged P-wave duration nor intracardiac atrial electrophysiology could predict arrhythmia recurrence after pulmonary vein isolation.
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Arroja et al. (2016) conducted a case-control in Paroxysmal atrial fibrillation (n=57). Paroxysmal atrial fibrillation vs. Age-matched controls without a history of AF was evaluated on Total P wave duration (p=0.004). Patients with paroxysmal atrial fibrillation had longer total P-wave duration (140 vs 123 ms, p=0.004) and conduction delays than controls, but these did not predict AF recurrence after ablation.
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