New Parameter of the Second Half of the P-Wave, P-Wave Duration, and Atrial Conduction Times Predict Atrial Fibrillation during Electrophysiological Studies

Abstract

Objective: Several P-wave parameters reflect atrial conduction characteristics and have been used to predict atrial fibrillation (AF). The aim of this study was to determine the relationship between maximum P-wave duration (PMax) and new P-wave parameters, with atrial conduction times (CT), and to assess their predictive value of AF during electrophysiological studies (AF-EPS).

Subjects and methods: This was a cross-sectional study in 153 randomly selected patients aged 18-70 years, undergoing EPS. The patients were divided into 2 groups designated as no AF-EPS and AF-EPS, depending on whether AF occurred during EPS or not. Different P-wave parameters and atrial CT were compared for both study groups. Subsequently, the predictive value of the P-wave parameters and the atrial CT for AF-EPS was evaluated.

Results: The values of CT, PMax, and maximum Ppeak-Pend interval (Pp-eMax) were significantly higher in patients with AF-EPS. Almost all P-wave parameters were correlated with the left CT. PMax, Pp-eMax, and CT were univariate and multivariate predictors of AF-EPS. The largest ROC area was presented by interatrial CT (0.852; p < 0.001; cutoff value: ≥82.5 ms; sensitivity: 91.1%; specificity: 81.1%). Pp-eMax showed greater sensitivity (79.5%) to discriminate AF-EPS than PMax (72.7%), but the latter had better specificity (60.4% vs. 41.5%).

Conclusions: Left atrial CT were directly and significantly correlated with PMax and almost all the parameters of the second half of the P-wave. CT, PMax, and Pp-eMax (new parameter) were good predictors of AF-EPS, although CT did more robustly.

Keywords: Atrial conduction time; Atrial fibrillation; Electrocardiogram; Electrophysiological study; P-wave.

Fig. 1

ROC curves showing the relationship between sensitivity and specificity through all possible values of atrial conduction times and P-wave parameters that define patients with atrial fibrillation in the electrophysiological study. a Analysis for atrial conduction times and b analysis for P-wave parameters. ROC, receiver operating characteristic; AUC, area under the ROC curve; DCS-PCS, left intra-atrial conduction time; P-DCS, P-distal coronary sinus interval; PMax, maximum P-wave duration; P-PCS, P-proximal coronary sinus interval; Pp-eMax, maximum Ppeak-Pend interval.