Prolonged P‐wave duration in sinus rhythm pre‐ablation is associated with atrial fibrillation recurrence after pulmonary vein isolation—A systematic review and meta‐analysis

Objective:To identify clinical, ECG and blood-based biomarkers associated with atrial fibrillation (AF) detection after ischaemic stroke or transient ischaemic attack (TIA) that could help inform patient selection for cardiac monitoring.Methods:We performed a systematic review and meta-analysis and searched electronic databases for cohort studies from 15/01/2000-15/01/2020. The outcome was AF ≥30 seconds within one year after ischaemic stroke/TIA. We used random effects models to create summary estimates of risk. Risk of bias was assessed using the Quality in Prognostic Studies tool. PROSPERO registration: CRD42020168307.Results:We identified 8503 studies, selected 34 studies and assessed 69 variables (42 clinical, 20 ECG and seven blood-based biomarkers). The studies included 11569 participants and AF was detected in 1478 people (12.8%). Overall, risk of bias was moderate. Variables associated with increased likelihood of AF detection are older age (OR 3.26, 95%CI 2.35-4.54), female sex (OR 1.47, 95%CI 1.23-1.77), a history of heart failure (OR 2.56, 95%CI 1.87-3.49), hypertension (OR 1.42, 95%CI 1.15-1.75) or ischaemic heart disease (OR 1.80, 95%CI 1.34-2.42), higher modified Rankin Scale (OR 6.13, 95%CI 2.93-12.84) or National Institutes of Health Stroke Scale score (OR 2.50, 95%CI 1.64-3.81), no significant carotid/intracranial artery stenosis (OR 3.23, 95%CI 1.14-9.11), no tobacco use (OR 1.93, 95%CI 1.48-2.51), statin therapy (OR 2.07, 95%CI 1.14-3.73), stroke as index diagnosis (OR 1.59, 95%CI 1.17-2.18), systolic blood pressure (OR 1.61, 95%CI 1.16-2.22), intravenous thrombolysis treatment (OR 2.40, 95%CI 1.83-3.16), atrioventricular block (OR 2.12, 95%CI 1.08-4.17), left ventricular hypertrophy (OR 2.21, 95%CI 1.03-4.74), premature atrial contraction (OR 3.90, 95%CI 1.74-8.74), maximum P-wave duration (OR 3.19, 95%CI 1.40-7.25), PR interval (OR 2.32, 95%CI 1.11-4.83), P-wave dispersion (OR 7.79, 95%CI 4.16-14.61), P-wave index (OR 3.44, 95%CI 1.87-6.32), QTc interval (OR 3.68, 95%CI 1.63-8.28), brain natriuretic peptide (OR 13.73, 95%CI 3.31-57.07) and HDL-cholesterol (OR 1.49, 95%CI 1.17-1.88) concentrations. Variables associated with reduced likelihood are minimum P-wave duration (OR 0.53, 95%CI 0.29-0.98), LDL-cholesterol (OR 0.73, 95%CI 0.57-0.93) and triglyceride (OR 0.51, 95%CI 0.41-0.64) concentrations.Discussion:We have identified multi-modal biomarkers that could help guide patient selection for cardiac monitoring after ischaemic stroke/TIA. Their prognostic utility should be prospectively assessed with AF detection and recurrent stroke as outcomes.

Download Full-text

Electrocardiogram characteristics of P wave associated with successful pulmonary vein isolation in patients with paroxysmal atrial fibrillation: Significance of changes in P‐wave duration and notched P wave

Annals of Noninvasive Electrocardiology ◽

10.1111/anec.12712 ◽

2019 ◽

Vol 25 (2) ◽

Cited By ~ 1

Author(s):

Satoshi Yanagisawa ◽

Yasuya Inden ◽

Hiroya Okamoto ◽

Aya Fujii ◽

Yusuke Sakamoto ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Paroxysmal Atrial Fibrillation ◽

P Wave ◽

Wave Duration ◽

P Wave Duration

Download Full-text

Prediction of the Efficacy of Pulmonary Vein Isolation for the Treatment of Atrial Fibrillation by the Signal-Averaged P-Wave Duration

Pacing and Clinical Electrophysiology ◽

10.1111/j.1540-8159.2007.00670.x ◽

2007 ◽

Vol 30 (3) ◽

pp. 304-313 ◽

Cited By ~ 27

Author(s):

YASUO OKUMURA ◽

ICHIRO WATANABE ◽

KIMIE OHKUBO ◽

SONOKO ASHINO ◽

MASAYOSHI KOFUNE ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

P Wave ◽

Wave Duration ◽

P Wave Duration

Download Full-text

Left atrial anatomy, atrial fibrillation burden, and P-wave duration—relationships and predictors for single-procedure success after pulmonary vein isolation

EP Europace ◽

10.1093/europace/euw376 ◽

2016 ◽

Vol 20 (2) ◽

pp. 271-278 ◽

Cited By ~ 10

Author(s):

Sven Knecht ◽

Maurice Pradella ◽

Tobias Reichlin ◽

Aline Mühl ◽

Matthias Bossard ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Left Atrial ◽

P Wave ◽

Wave Duration ◽

Single Procedure ◽

P Wave Duration ◽

Atrial Fibrillation Burden

Download Full-text

Short P‐Wave Duration is a Marker of Higher Rate of Atrial Fibrillation Recurrences after Pulmonary Vein Isolation: New Insights into the Pathophysiological Mechanisms Through Computer Simulations

Journal of the American Heart Association ◽

10.1161/jaha.120.018572 ◽

2021 ◽

Author(s):

Angelo Auricchio ◽

Tardu Özkartal ◽

Francesca Salghetti ◽

Laura Neumann ◽

Simone Pezzuto ◽

...

Keyword(s):

Atrial Fibrillation ◽

Action Potential ◽

Pulmonary Vein ◽

Computer Simulations ◽

Pulmonary Vein Isolation ◽

Action Potential Duration ◽

P Wave ◽

Wave Duration ◽

P Wave Duration ◽

Af Recurrence

Background Short ECG P‐wave duration has recently been demonstrated to be associated with higher risk of atrial fibrillation (AF). The aim of this study was to assess the rate of AF recurrence after pulmonary vein isolation in patients with a short P wave, and to mechanistically elucidate the observation by computer modeling. Methods and Results A total of 282 consecutive patients undergoing a first single‐pulmonary vein isolation procedure for paroxysmal or persistent AF were included. Computational models studied the effect of adenosine and sodium conductance on action potential duration and P‐wave duration (PWD). About 16% of the patients had a PWD of 110 ms or shorter (median PWD 126 ms, interquartile range, 115 ms–138 ms; range, 71 ms–180 ms). At Cox regression, PWD was significantly associated with AF recurrence ( P =0.012). Patients with a PWD <110 ms (hazard ratio [HR], 2.20; 95% CI, 1.24–3.88; P =0.007) and patients with a PWD ≥140 (HR, 1.87, 95% CI, 1.06–3.30; P =0.031) had a nearly 2‐fold increase in risk with respect to the other group. In the computational model, adenosine yielded a significant reduction of action potential duration 90 (52%) and PWD (7%). An increased sodium conductance (up to 200%) was robustly accompanied by an increase in conduction velocity (26%), a reduction in action potential duration 90 (28%), and PWD (22%). Conclusions One out of 5 patients referred for pulmonary vein isolation has a short PWD which was associated with a higher rate of AF after the index procedure. Computer simulations suggest that shortening of atrial action potential duration leading to a faster atrial conduction may be the cause of this clinical observation.

Download Full-text