What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation (n=87). Intervention: Post-PVI LP20/FPD ratio > 0.015 µV/ms vs. Post-PVI LP20/FPD ratio ≤ 0.015 µV/ms. Primary outcome: Recurrence of paroxysmal atrial fibrillation (p=0.0027).

January 1, 2017Open Access

New Parameter to Predict Recurrence of Paroxysmal Atrial Fibrillation after Pulmonary Vein Isolation by the P-Wave Signal-Averaged Electrocardiogram

YMYumi MunetsuguShowa University MKMitsuharu KawamuraMakita Corporation (Japan)KTKaoru TannoShowa University Hospital

Key Result

A post-pulmonary vein isolation LP20/FPD ratio > 0.015 µV/ms was significantly associated with a higher risk of paroxysmal atrial fibrillation recurrence (P=0.0027), demonstrating 90% sensitivity and 60% specificity.

Study Design

Type

Cohort (n=87)

Multicenter

Structured PICO

Does a post-PVI LP20/FPD ratio >0.015 µV/ms on P-wave signal-averaged electrocardiogram predict the recurrence of paroxysmal atrial fibrillation in patients undergoing initial pulmonary vein isolation?

Population

87 patients with idiopathic paroxysmal or persistent atrial fibrillation (LVEF ≥ 50%, BNP ≤ 200 pg/ml) undergoing initial pulmonary vein isolation, followed for a mean of 12 months.

Exposure

Post-PVI P-wave signal-averaged electrocardiogram (P-SAECG) showing an LP20/FPD ratio >0.015 µV/ms, recorded within 1 week after the initial PVI session.

Comparator

Post-PVI P-wave signal-averaged electrocardiogram (P-SAECG) showing an LP20/FPD ratio ≤0.015 µV/ms.

Outcome

Recurrence of atrial fibrillation (paroxysmal or persistent) evaluated by 12-lead ECG and 24-h ECG recording during a mean follow-up of 12 ± 7 months.

The post-PVI LP20/FPD ratio derived from a P-wave signal-averaged electrocardiogram is a useful novel noninvasive parameter for predicting the recurrence of paroxysmal atrial fibrillation after initial pulmonary vein isolation.

Main Result

p-value: p=0.0027

Limitations

Measurement of the P-SAECG is sometimes difficult because of noise, inappropriate cardiac rhythms, or overlap between the end of the P-wave and the beginning of the QRS complex.
Definition of atrial late potentials was arbitrary because there are no established criteria.
Pre-ablation antiarrhythmic drug therapy was not discontinued and treatment was maintained after the procedure.
Asymptomatic recurrence may have occurred during the follow-up period and the rate of recurrence may have been underestimated.

Abstract

Noninvasive methods for predicting the recurrence of atrial fibrillation (AF) after initial pulmonary vein isolation (PVI) have not been well described. The aim of the present study was to evaluate the usefulness of the P-wave signal-averaged electrocardiogram (P-SAECG) in predicting the recurrence of AF after initial PVI. The P-SAECG was recorded before and after (within 1 week) the initial PVI session. The filtered P-wave duration (FPD) and root mean square voltage of the last 20ms of the filtered P-wave (LP20) were measured in 87 consecutive idiopathic AF patients (ejection fraction ≥50%, B-type natriuretic peptide ≤200pg/ml). During the follow-up period (12±7 months), 22 of 87 (25%) patients had recurrence of AF (11 with paroxysmal AF and 11 with persistent AF). In the group with recurrence of paroxysmal AF, the post-PVI FPD was significantly shorter and the post-PVI LP20 was significantly larger than in the non-recurrence group. Furthermore, the post-PVI LP20/FPD ratio was significantly higher in the group with paroxysmal AF recurrence than in the non-recurrence group (0.024±0.009 vs 0.015±0.007µV/ms, respectively; P0.015µV/ms than in those with a post-PVI LP20/FPD ≤0.015µV/ms. The optimal post-PVI LP20/FPD cut-off value of 0.015µV/ms had a sensitivity of 90% and a specificity of 60%. The data also suggest that the post-PVI LP20/FPD may be a new parameter for predicting successful PVI in patients with idiopathic paroxysmal AF after PVI.

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