scholarly journals Splitting the P-Wave: Improved Evaluation of Left Atrial Substrate Modification after Pulmonary Vein Isolation of Paroxysmal Atrial Fibrillation

Sensors ◽  
2021 ◽  
Vol 22 (1) ◽  
pp. 290
Author(s):  
Aikaterini Vraka ◽  
Vicente Bertomeu-González ◽  
Fernando Hornero ◽  
Aurelio Quesada ◽  
Raúl Alcaraz ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Paroxysmal Atrial Fibrillation ◽  
P Wave ◽  
Conduction Time ◽  
Wave Duration ◽  
Substrate Modification ◽  
P Wave Duration ◽  
Before And After

Atrial substrate modification after pulmonary vein isolation (PVI) of paroxysmal atrial fibrillation (pAF) can be assessed non-invasively by analyzing P-wave duration in the electrocardiogram (ECG). However, whether right (RA) and left atrium (LA) contribute equally to this phenomenon remains unknown. The present study splits fundamental P-wave features to investigate the different RA and LA contributions to P-wave duration. Recordings of 29 pAF patients undergoing first-ever PVI were acquired before and after PVI. P-wave features were calculated: P-wave duration (PWD), duration of the first (PWDon-peak) and second (PWDpeak-off) P-wave halves, estimating RA and LA conduction, respectively. P-wave onset (PWon-R) or offset (PWoff-R) to R-peak interval, measuring combined atrial/atrioventricular and single atrioventricular conduction, respectively. Heart-rate fluctuation was corrected by scaling. Pre- and post-PVI results were compared with Mann–Whitney U-test. PWD was correlated with the remaining features. Only PWD (non-scaling: Δ=−9.84%, p=0.0085, scaling: Δ=−17.96%, p=0.0442) and PWDpeak-off (non-scaling: Δ=−22.03%, p=0.0250, scaling: Δ=−27.77%, p=0.0268) were decreased. Correlation of all features with PWD was significant before/after PVI (p<0.0001), showing the highest value between PWD and PWon-R (ρmax=0.855). PWD correlated more with PWDon-peak (ρ= 0.540–0.805) than PWDpeak-off (ρ= 0.419–0.710). PWD shortening after PVI of pAF stems mainly from the second half of the P-wave. Therefore, noninvasive estimation of LA conduction time is critical for the study of atrial substrate modification after PVI and should be addressed by splitting the P-wave in order to achieve improved estimations.

Abstract 2023: Effect Of Chronic Stretch Reversal On Atrial Remodeling In Humans: Implications For The Atrial Fibrillation Substrate

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Bobby John ◽  
Martin K Stiles ◽  
Sunil T Chandy ◽  
Pawel K Kuklik ◽  
Glenn D Young ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Important Determinant ◽  
P Wave ◽  
Atrial Remodeling ◽  
Conduction Time ◽  
Atrial Arrhythmias ◽  
Wave Duration ◽  
P Wave Duration ◽  
Before And After ◽  
Mitral Commissurotomy

Background : Chronic atrial stretch is an important determinant for atrial fibrillation (AF). Whether relief of stretch reverses the substrate predisposed to AF is unknown. Methods: Twenty one pts (31±9 years) with mitral stenosis (MS; MVA 0.89±0.1cm 2 ) undergoing mitral commissurotomy (MC) were studied by electrophysiological or electroanatomical mapping of both atria before and after MC. Multipolar catheters were placed in the lateral RA, Crista (CT), coronary sinus (CS), septal RA and LA. We measured: effective refractory period (ERP) at the LA appendage, septal/lateral LA roof, posterior LA, inferior LA, proximal/distal CS, low/high LRA and SRA at 600 and 450ms; P wave duration (PWD); double potentials (DP) or fractionated signals (FS) along CT; and conduction time along CS, LRA, inferior LA and LA roof. Activation and voltage maps were created to evaluate changes in conduction and voltage. In 14 pts, RA studies were repeated ≥6 months after MC. Results : Following MC, there was significant increase in MVA (2.1±0.3 cm 2, p<0.0001) with decrease in LA (23±8 to 10±4 mmHg, p<0.0001) and PA pressures (38±17 to 27±14mmHg, p<0.0001) and LA volume (75±12 to 52±13ml, p<0.0001). This was associated with no change in ERP and No. of DP/FS along the CT but with reduction in PWD (139±19 to 135±20ms, p=0.047), increase in conduction velocity (CV) in LA (1.3±0.3 to 1.7±0.2m/s, p=0.005) and RA (1.0±0.1 to 1.3±0.3 m/s, p=0.007) and increase in LA voltage (1.7±0.6 to 2.5±1.0 mV, p=0.05). Late after MC, there was a further decrease in PWD and RA ERP, with increase in RA CV (1.0±0.1 to 1.3±0.2 m/s, p=0.01) and voltage (1.7±0.7 to 2.8±0.6 mV, p=0.004) but with no change in other parameters. See table for details of pts studied late after MC. Conclusion: The electrophysiologic and electroanatomic abnormalities within the atria that result from MS are reversed after MC. These observations suggest that the substrate predisposing to atrial arrhythmias may be reversed. Results

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

2007 ◽  
Vol 30 (3) ◽  
pp. 304-313 ◽  
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

scholarly journals 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

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.

scholarly journals The P wave duration in patients with atrial fibrillation undergoing cryoballoon pulmonary vein isolation. Preliminary results.

2018 ◽  
Vol 1 (1) ◽  
pp. 42-45
Author(s):  
Jacek Zawadzki ◽  
Jakub Adamowicz ◽  
Agnieszka Sławuta ◽  
Aleksandra Gajek ◽  
Dorota Zyśko ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
P Wave ◽  
Preliminary Results ◽  
Wave Duration ◽  
P Wave Duration

scholarly journals Timing of Atrial Fibrillation Recurrence Following Pulmonary Vein Isolation and Serial Changes of P-Wave Duration

2011 ◽  
Vol 27 (Supplement) ◽  
pp. OP37_2
Author(s):  
Yasuyuki Egami ◽  
Masami Nishino ◽  
Masayuki Taniike ◽  
Nobuhiko Makino ◽  
Hiroyasu Kato ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
P Wave ◽  
Atrial Fibrillation Recurrence ◽  
Wave Duration ◽  
P Wave Duration

scholarly journals Is there a change in P wave parameters following pulmonary vein isolation (PVI) using radiofrequency ablation (RF) vs. cryoballoon ablation (CRYO) for paroxysmal atrial fibrillation (PAF)?

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
I Antoun ◽  
S Bharat ◽  
A Mavilakandy ◽  
V Pooranachandran ◽  
GA Ng
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Paroxysmal Atrial Fibrillation ◽  
P Wave ◽  
Cryoballoon Ablation ◽  
Single Shot ◽  
P Waves ◽  
Significant Difference ◽  
Before And After

Abstract Funding Acknowledgements Type of funding sources: None. Pulmonary vein isolation (PVI) is an effective and established therapy for paroxysmal atrial fibrillation (PAF) . PVI can be performed using point by point ablation with radiofrequency (RF) or with single shot techniques such as cryoballoon (CRYO). As P waves represent atrial depolarization, we aimed to study whether P wave metrics may change after PVI and if there are differences between RF and CRYO approaches. Methods We studied 88 matched patients who had PVI for PAF between January 2017 and December 2018 (RF = 44, CRYO = 44). Each patient was in sinus rhythm (SR) prior to ablation. Patients on amiodarone and those who had additional linear ablation were excluded. Patients had continuous ECG monitoring using Labsystem Pro (Boston Scientific Inc). Sampled at 1kHz during the procedure. One-minute recordings before and after PVI were exported and analysed using custom-written software using MatLab (v2018, bandpass 1-50Hz) to annotate P wave onset, peak and end. P wave duration was heart rate corrected (PWDc) by using the Hodges formula and P wave amplitude (PWA). Results P wave metrics were comparable before PVI between both cohorts. Successful PVI was achieved in all patients. There was a trend towards an increase in PWDc in some ECG leads with either RF or CRYO but no significant difference in P wave metrics as a result of PVI ablation or between both ablation modalities. Conclusion In this study, there was no significant change seen in PVI with RF or CRYO and no difference between the 2 ablation modalities. P wave metrics comparison, RF vs CRYO PWDc (ms) PRE, RF (n = 44) POST, RF (n = 44) P PRE, CRYO (n = 44) POST CRYO (n = 44) P P (RF vs CRYO) I 134.7 ± 32 133.5 ± 35 0.813 131.9 ± 36 132.7 ± 39 0.9 0.81 II 140.9 ± 34 144.1 ± 37 0.56 139.4 ± 42 134.4 ± 40 0.51 0.41 III 131.5 ± 31 143.3 ± 37 0.04 132.8 ± 41 130.6 ± 36 0.68 0.074 AVF 137 ± 32 144.7 ± 36 0.15 137.5 ± 42 127.4 ± 37 0.11 0.141 V1 143.9 ± 33 151.8 ± 37 0.17 133.6 ± 37 143.8 ± 38 0.09 0.745 PWA (mV) PRE, RF (n = 44) POST, RF (n = 44) P PRE, CRYO (n = 44) POST CRYO (n = 44) P P (RF vs CRYO) I 0.125 ± 0.08 0.09 ± 0.06 0.002 0.13 ± 0.08 0.14 ± 0.09 0.59 0.076 II 0.238 ± 0.1 0.238 ± 0.1 0.98 0.232 ± 0.1 0.278 ± 0.2 0.1 0.212 III 0.149 ± 0.1 0.153 ± 0.1 0.83 0.189 ± 0.1 0.187 ± 0.1 0.97 0.86 AVF 0.195 ± 0.1 0.196 ± 0.1 0.92 0.197 ± 0.1 0.247 ± 0.1 0.066 0.132 V1 0.122 ± 0.1 0.151± 0.1 0.05 0.138 ± 0.1 0.193 ± 0.2 0.002 0.543 PWDc and PWA comparison following RF vs CRYO.

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