Ratio of P-Wave Duration to P-Wave Amplitude and Left Atrial Remodeling: Insights from Electrophysiological Findings and Myocardial Injury After Cryoballoon Ablation

The impact of the P-wave morphology on clinical outcomes postcatheter ablation (post-CA) and recurrent arrhythmia characteristics or electrophysiologic findings in patients with paroxysmal atrial fibrillation (PAF) remains unclear. Patients with PAF who underwent cryoballoon ablation were enrolled....

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Published in:The American journal of cardiology 2024-02, Vol.212, p.109-117
Main Authors: Yano, Masamichi, Egami, Yasuyuki, Kawanami, Shodai, Ukita, Kohei, Kawamura, Akito, Yasumoto, Koji, Tsuda, Masaki, Okamoto, Naotaka, Matsunaga-Lee, Yasuharu, Nishino, Masami
Format: Article
Language:English
Subjects:
Ablation
Amplitudes
Arrhythmia
Blood
Cardiac arrhythmia
Catheters
EKG
Electric potential
Electrocardiography
Fibrillation
Neurological disorders
P waves
Statistical analysis
Tachycardia
Troponin I
Veins & arteries
Voltage
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Summary:The impact of the P-wave morphology on clinical outcomes postcatheter ablation (post-CA) and recurrent arrhythmia characteristics or electrophysiologic findings in patients with paroxysmal atrial fibrillation (PAF) remains unclear. Patients with PAF who underwent cryoballoon ablation were enrolled. In 12-lead electrocardiography recorded within 1 month before CA, the P-wave duration (Pd) and P-wave vector magnitude (Pvm) (square root of the sum of the squared P-wave amplitude in leads II, V , and one-half of the P-wave amplitude in V ) were measured and divided into 2 groups: patients with high and low Pd/Pvm based on a statistically calculated cut-off value. We evaluated the incidence of late recurrence of atrial fibrillation (LRAF), myocardial injury (high-sensitive troponin I), and the electrophysiologic findings in repeat ablation sessions. This study included 269 patients with PAF. The median follow-up duration was 697 days. The cut-off value of the Pd/Pvm for predicting LRAF was 740.7 ms/mV (area under the curve = 0.81, sensitivity = 58.2%, and specificity = 89.6%). Multivariable Cox proportional hazards analysis showed that high Pd/Pvm (>740.7 ms/mV) was significantly associated with LRAF (p 3 was significantly higher in those with high than low Pd/Pvm (p = 0.044 and p = 0.002, respectively). In the repeat ablation sessions, the Pd/Pvm in patients with atrial tachycardia-induced or spontaneously occurring during the repeat CA sessions was significantly higher than in those without (p = 0.009). There was a significant difference between the Pd/Pvm and low-voltage area (p
ISSN:0002-9149
1879-1913
1879-1913
DOI:10.1016/j.amjcard.2023.11.046