Long P-wave duration immediately after pulmonary vein isolation on radiofrequency catheter ablation for atrial fibrillation predicts clinical recurrence: correlation with atrial remodeling in persistent atrial fibrillation

Introduction: The radiofrequency catheter ablation (RFCA) is challenging in patients with long-standing persistent atrial fibrillation (PeAF) and its clinical outcome is highly variable. Genome-wide association studies (GWAS) have identified that the rs2106261 polymorphism in ZFHX3 is associated with non-valuvluar AF. Hypothesis: We tested the association between the “super-responder” to the radiofrequency catheter ablation (RFCA) and the rs2106261 polymorphism among the patients with long-standing persistent AF. Methods: We included consecutive 207 patients with long-standing PeAF (79.2% male, age 58.0±9.7 years and follow-up interval 21 (16-34) months) who underwent RFCA for symptomatic long-standing PeAF. The super-responders were defined as the patients without early or clinical recurrence of AF at least for 12 months of post-procedural follow-up period without taking anti-arrhythmic drug. We looked for the characteristics of super-responders in clinical profiles, ECG in sinus rhythm, 3D-left atrial (LA) CT, or genotypes of the rs2106262. Results: 1. Fifty two patients (25.1%) were categorized as super-responders. Super-responders were younger (55.5±9.6 vs. 58.9±9.6 years old, p=0.028) and had shorter AF duration (44.9 [25.4-73.1] vs. 65.1 [34.1-113.6] month, p=0.010), shorter QTc (435.1±27.8 vs. 447.3±29.1 msec, p=0.007), lower negative P wave amplitude in lead V1 (0.07±0.03 vs. 0.08±0.04, p=0.034), and smaller LA volume index (CT) (75.2±21.0 vs. 88.2±24.1, p=0.001) than recurred patient group. 2. In additive model, the minor allele frequency of the rs2106261 was higher in super-responders (52.2%) than in recurred group (40.9%, p=0.058). 3. In multivariate analyses, LA volume index (adjusted OR=0.973, 95% CI 0.955-0.992, p=0.006) and genetic polymorphism of the rs2106261 (adjusted OR=1.808, 95% CI 1.034-3.163, p=0.038) were independently associated with super-responder to RFCA among the patients with long-standing persistent AF. Conclusion: Although the recurrence rate after catheter ablation for long-standing persistent AF is still high, pre-procedural LA volume index or the rs2106261 polymorphism may be helpful for the selection of good candidate for RFCA.

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Prolonged P-wave duration is associated with atrial fibrillation recurrence after radiofrequency catheter ablation: A systematic review and meta-analysis

International Journal of Cardiology ◽

10.1016/j.ijcard.2016.11.058 ◽

2017 ◽

Vol 227 ◽

pp. 355-359 ◽

Cited By ~ 12

Author(s):

Yao-Sheng Wang ◽

Guang-Yu Chen ◽

Xue-Hai Li ◽

Xin Zhou ◽

Yi-Gang Li

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Catheter Ablation ◽

Radiofrequency Catheter Ablation ◽

Meta Analysis ◽

P Wave ◽

Atrial Fibrillation Recurrence ◽

Wave Duration ◽

P Wave Duration

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Maximum P-Wave Duration and P-Wave Dispersion Predict Recurrence of Paroxysmal Atrial Fibrillation in Patients with Wolff-Parkinson-White Syndrome after Successful Radiofrequency Catheter Ablation

Journal of Interventional Cardiac Electrophysiology ◽

10.1023/b:jice.0000035925.90831.80 ◽

2004 ◽

Vol 11 (1) ◽

pp. 21-27 ◽

Cited By ~ 15

Author(s):

Kudret Aytemir ◽

Basri Amasyali ◽

Sedat Kose ◽

Ayhan Kilic ◽

Gulcan Abali ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Radiofrequency Catheter Ablation ◽

Wave Dispersion ◽

P Wave ◽

P Wave Dispersion ◽

White Syndrome ◽

Wave Duration ◽

P Wave Duration ◽

Wolff Parkinson White Syndrome

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209 Signal-averaged P wave duration in patients with atrial fibrillation treated with radiofrequency catheter ablation

EP Europace ◽

10.1016/s1099-5129(05)80121-7 ◽

2005 ◽

Vol 7 ◽

pp. 41-41

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Radiofrequency Catheter Ablation ◽

P Wave ◽

Wave Duration ◽

P Wave Duration

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Effectiveness of P-wave ECG index and left atrial appendage volume in predicting atrial fibrillation recurrence after first radiofrequency catheter ablation

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-01930-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ruibin Li ◽

Xiaohong Yang ◽

Min Jia ◽

Dong Wang ◽

Xiaoran Cui ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Radiofrequency Catheter Ablation ◽

P Wave ◽

Atrial Fibrillation Recurrence ◽

Interval Prolongation ◽

Wave Duration ◽

P Wave Duration ◽

Pr Interval ◽

Recurrence Group

Abstract Background The primary aim was to observe the predictive value of P-wave ECG index and left atrial appendage volume (LLAV) for atrial fibrillation recurrence after first radiofrequency catheter ablation. Methods A total of 196 patients with paroxysmal atrial fibrillation were enrolled. The preoperative LLAV was measured by cardiac enhanced CT. The P-wave ECG index including minimum P-wave duration (P-min), maximum P-wave duration (P-max), mean P-wave duration (mPWD), P-wave dispersion (PWD), P-wave terminal force in lead V1 (PtfV1), PR interval prolongation, and interatrial block (IAB) were analyzed and recorded in 12-lead ECG of sinus rhythm. Results According to the follow-up results, the patients were divided into two groups: the non-recurrence group and the recurrence group. P-min, PWD, P-max, PtfV1 ≥ 0.04 mV·s, PR interval prolongation, and the ratio of first and third-degree IAB in the recurrence group were higher than those in the non-recurrence group, with significant statistical differences (P < 0.05). Kaplan–Meier curve analysis was performed on time to atrial fibrillation recurrence after catheter ablation when PtfV1 ≥ 0.04 mv s by comparison between groups (Log Rank test: 2 = 4.739, P < 0.001). Kaplan–Meier curve analysis showed that the survival rate without recurrence of atrial fibrillation after catheter ablation was lower when the LLAV exceeded 8.0 mL (log-rank test P < 0.001). Conclusion PWD, P-max, PtfV1, PR interval prolongation, first and third-degree IAB, and LLAV can effectively predict atrial fibrillation recurrence after radiofrequency catheter ablation. The combination might be a valid and alternative independent predictor of recurrence.

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