Key result
Prolonged P-wave duration linked to ~2-fold higher risk of AF recurrence after ablation.
Why the study?
Catheter ablation reduces AF burden and symptoms, but AF recurrence remains an issue, and simple predictors like P-wave duration could help improve therapy.
Does prolonged baseline P-wave duration predict atrial fibrillation recurrence in patients undergoing catheter ablation?
Meta-Analysis (n=4,175)
Yes
Does prolonged baseline P-wave duration predict atrial fibrillation recurrence in patients undergoing catheter ablation?
Odds Ratio: 2.04 (95% CI 1.16–3.58)
p-value: p=0.01
Pre-procedural P-wave duration prolongation is exponentially associated with an increased risk of atrial fibrillation recurrence after catheter ablation, providing a simple marker for risk stratification.
May aid pre-ablation AF recurrence risk stratification; leaves open prospective validation before guiding practice.
AIMS: Atrial fibrillation (AF) is a global health problem with high morbidity and mortality. Catheter ablation (CA) can reduce AF burden and symptoms, but AF recurrence (AFr) remains an issue. Simple AFr predictors like P-wave duration (PWD) could help improve AF therapy. This updated meta-analysis reviews the increasing evidence for the association of AFr with PWD and offers practical implications. METHODS AND RESULTS: Publication databases were systematically searched and cohort studies reporting PWD and/or morphology at baseline and AFr after CA were included. Advanced interatrial block (aIAB) was defined as PWD ≥ 120 ms and biphasic morphology in inferior leads. Random-effects analysis was performed using the Review Manager 5.3 and R programs after study selection, quality assessment, and data extraction, to report odds ratio (OR) and confidence intervals. : Among 4175 patients in 22 studies, 1138 (27%) experienced AFr. Patients with AFr had longer PWD with a mean pooled difference of 7.8 ms (19 studies, P < 0.001). Pooled OR was 2.04 (1.16-3.58) for PWD > 120 ms (13 studies, P = 0.01), 2.42 (1.12-5.21) for PWD > 140 ms (2 studies, P = 0.02), 3.97 (1.79-8.85) for aIAB (5 studies, P < 0.001), and 10.89 (4.53-26.15) for PWD > 150 ms (4 studies, P < 0.001). There was significant heterogeneity but no publication bias detected. CONCLUSION: P-wave duration is an independent predictor for AF recurrence after left atrium ablation. The AFr risk is increasing exponentially with PWD prolongation. This could facilitate risk stratification by identifying high-risk patients (aIAB, PWD > 150 ms) and adjusting follow up or interventions.
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Intzes et al. (2022) conducted a meta-analysis in Atrial fibrillation undergoing catheter ablation (n=4,175). Prolonged P-wave duration vs. Shorter or normal P-wave duration was evaluated on Atrial fibrillation recurrence after catheter ablation (OR 2.04, 95% CI 1.16-3.58, p=0.01). Prolonged P-wave duration (>120 ms) at baseline was associated with a significantly increased risk of atrial fibrillation recurrence after catheter ablation (OR 2.04).
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