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. 2016 Jan-Feb;16(1):3-7.
doi: 10.1016/j.ipej.2016.02.010. Epub 2016 Feb 12.

Change in P wave morphology after convergent atrial fibrillation ablation

Suvash Shrestha  1 , On Chen  2 , Mary Greene  3 , Jinu Jacob John  4 , Yisachar Greenberg  5 , Felix Yang  6
Affiliations

Change in P wave morphology after convergent atrial fibrillation ablation

Suvash Shrestha et al. Indian Pacing Electrophysiol J. 2016 Jan-Feb.

Abstract

Convergent atrial fibrillation ablation involves extensive epicardial as well as endocardial ablation of the left atrium. We examined whether it changes the morphology of the surface P wave. We reviewed electrocardiograms of 29 patients who underwent convergent ablation for atrial fibrillation. In leads V1, II and III, we measured P wave duration, area and amplitude before ablation, and at 1, 3 and 6 months from ablation. After ablation, there were no significant changes in P wave amplitude, area, or duration in leads II and III. There was a significant reduction in the area of the terminal negative deflection of the P wave in V1 from 0.38 mm(2) to 0.13 mm(2) (p = 0.03). There is also an acute increase in the amplitude and duration of the positive component of the P wave in V1 followed by a reduction in both by 6 months. Before ablation, 62.5% of the patients had biphasic P waves in V1. In 6 months, only 39.2% of them had biphasic P waves. Hybrid ablation causes a reduction of the terminal negative deflection of the P wave in V1 as well as temporal changes in the duration and amplitude of the positive component of the P wave in V1. This likely reflects the reduced electrical contribution of the posterior left atrium after ablation as well as anatomical and autonomic remodeling. Recognition of this altered sinus P wave morphology is useful in the diagnosis of atrial arrhythmias in this patient population.

Keywords: Atrial fibrillation; Convergent ablation; P wave area; P wave duration.

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Figures

Fig. 1
Fig. 1
Schematic of the convergent ablation lesion pattern relative to the high stress regions. By anatomically targeting high stress regions associated with atrial remodeling, AF substrate is ablated or isolated.
Fig. 2
Fig. 2
Measurement of P wave area using sketchandcalc.
See this image and copyright information in PMC

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