Key result
Pre-ablation filtered P-wave duration fails to predict PAF recurrence after pulmonary vein isolation.
Why the study?
The clinical utility of P-wave signal-averaged ECG in predicting the recurrence of paroxysmal atrial fibrillation after pulmonary vein isolation was evaluated.
Cohort (n=93)
No
Answers are grounded in this paper and cite their sources.
SAECG may stratify post-PVI recurrence risk in PAF; leaves open whether it should guide patient selection or follow-up.
Background & purpose: Pulmonary vein isolation is an established treatment for paroxysmal atrial fibrillation (PAF).Electrophysiological abnormalities of the atrial muscle (which reflects atrial substrate for origin of AF) in patients with PAF can be detected non-invasivley using P wave signal averaging.The signal averaged ECG (SAECG) is an orthogonal ECG calculated using QRS as a trigger, with P wave being used as a template for signal averaging with fudicial point being shifted up to 400msec.we studied the clinical utility of SAECG in predicting the recurrence of PAF after PVI.Methods: 93 consecutive patients undergoing PVI at atertiary centre were prospectively recruited.Regional ethics committee approval was granted for the study.SAECG data was recorded prior to PVI using a Spider view high resoltuion ECG recording device (Sorin).Time domain analysis which measures a change in R-R interval in standard deviation of root mean sqaured velocities (voltages) at various time intervals RMS10,20,30 msec and fast fourier transformation was used to measure energies at various band frequencies (20-150Hz) are measured using validated software for P wave analysis.A flitered P wave duration (FPD) is measured using this software.All patients were followed for 12 months post PVI.Data has been analysed using unpaired t-tests.Results: (Mean þ /-SD): 93 patients had PVI for PAF and 22 patients had documented recurrence of PAF.There was no difference in preablation FPD of patients who had recurrence when compared to those who had no recurrence (143 þ /-15.89msecVs 144.3 þ /-13.6 msec, p ¼ 0.79) (Fig 1).Spectral analysis was performed on SAECG's which did not have any significant differences in the pre ablation parameters (Table 1). Conclusion:The study demonstrates that pre ablation FPD and spectral analysis is not an useful tool to predcit recurrence of PAF after PVI.A larger trial has to be performed to assess the utility of signal averaged P wave.However, our study reinforces the fact that prolonged P wave duration is common finding in patients who had PAF (FPD .140msec).RMS 10 1.89 þ /-1.2 (recurrence group) 2.62 þ /-2.04 uV RMS 20 2.88 þ /-1.88 Vs 3.48 þ /-2 uV RMS 30 3.96 þ /-2.12 Vs 4.49 þ /-3uV FDA20-15Hz 28.19 þ /-15.96Vs 31.07 þ /-20.22FDA30-150Hz 17.91 þ/-10.56Vs 20.03 þ /-16.76FDA 40-150HZ8.09þ /-4.89Vs 9.03 þ /-6.97 FDA 60-150Hz 2 þ /-1.15 Vs 2.08 þ /-1.2 FDA 80-150Hz 0.77 þ /-0.52 Vs0.þ /-0.53
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Varanasi et al. (2016) conducted a cohort in Paroxysmal atrial fibrillation (PAF) undergoing pulmonary vein isolation (PVI) (n=93). Pre-ablation signal-averaged ECG (SAECG) filtered P wave duration and spectral analysis vs. Recurrence of PAF vs no recurrence of PAF was evaluated on Pre-ablation filtered P wave duration (FPD) in patients with vs without documented recurrence of PAF (p=0.79). Pre-ablation filtered P wave duration did not predict PAF recurrence after pulmonary vein isolation.
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