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Controlled Clinical Trial
. 2007 Mar;30(3):304-13.
doi: 10.1111/j.1540-8159.2007.00670.x.

Prediction of the efficacy of pulmonary vein isolation for the treatment of atrial fibrillation by the signal-averaged P-wave duration

Yasuo Okumura  1 , Ichiro Watanabe, Kimie Ohkubo, Sonoko Ashino, Masayoshi Kofune, Kenichi Hashimoto, Atsushi Shindo, Hidezou Sugimura, Toshiko Nakai, Yuji Kasamaki, Satoshi Saito
Affiliations
Controlled Clinical Trial

Prediction of the efficacy of pulmonary vein isolation for the treatment of atrial fibrillation by the signal-averaged P-wave duration

Yasuo Okumura et al. Pacing Clin Electrophysiol. 2007 Mar.

Abstract

Background: The noninvasive methods for predicting a successful pulmonary vein isolation (PVI) have not been well described. The aim of this study was to assess the usefulness of the P-wave signal-averaged electrocardiogram (P-SAECG) in predicting the chance of a successful PVI in patients with atrial fibrillation (AF).

Methods: A P-SAECG was recorded before (pre), 1 day after, and 3-4 months after the PVI in 51 AF patients (41, paroxysmal AF; 10, persistent AF). Three-dimensional electroanatomic mapping (3D-EAM) of the right and left atria and left PVs was performed before PVI in 10 patients to analyze the biatrial conduction time (BAT).

Results: Fifteen patients suffered from AF recurrences 3 months or more after the PVI. The pre-filtered P-wave duration (FPD) was significantly longer in patients with recurrence than in those without (166.8 +/- 14.8 ms vs 145.9 +/- 12.6 ms, P < 0.0001). In both patient groups, PVI shortened the FPD, which continued for 3-4 months. Multivariate analysis revealed that a pre-FPD >150 ms was a powerful predictor for recurrence, but persistent AF, the left atrial dimension, and structural heart disease were not predictors for recurrence. 3D-EAM showed that the delayed activation point was located within the left PVs and the BAT was identical to the pre-FPD.

Conclusions: The pre-FPD may strongly reflect atrial dysfunction, and thus may be useful for predicting a successful PVI. Shortening of the FPD after the PVI and similar FPD and BAT values suggest that the last component of the FPD represents the activation of the left PVs.

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