Can changes in P-wave duration and area under the curve measured by SAECG noninvasively detect posterior left atrial reconnection in patients with recurrent atrial arrhythmias after PLAI?
Signal-averaged ECG measurements of P-wave duration and area under the curve can noninvasively and accurately detect posterior left atrial reconnection in patients with recurrent arrhythmias after ablation.
Background: Recurrent atrial arrhythmias (RAAs) following posterior left atrial isolation (PLAI) for atrial fibrillation are common and are associated with reconnection of the PLA and pulmonary veins. We aimed to show that P-wave duration (PWD) and P-wave area under the curve (PWAUC) changes in patients undergoing PLAI can be measured using signal-averaged electrocardiogram (SAECG), and that reversal of these changes in patients with RAAs can be used to noninvasively detect reconnection. Methods: SAECG recordings before and after PLAI in 52 patients were analyzed for changes in PWD and PWAUC and also in 26 of these patients who had a repeat procedure for RAA. Results: PWD and PWAUC reduced significantly in most leads following PLAI (mean 104 ± 11 ms to 93 ± 15 ms [P −0.29 μVs for detecting reconnection had a sensitivity of 94% and specificity of 100% (receiver operator characteristic area under the curve 0.97, P = 0.005). Conclusions: PLAI reduces PWD and PWAUC while reconnection increases them both. SAECG may be able to detect reconnection of the PLA noninvasively. (PACE 2010; 1324–1334)
Lim et al. (Thu,) studied this question.