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Meta-Analysis
. 2023 Feb 16;25(2):450-459.
doi: 10.1093/europace/euac210.

P-wave duration and atrial fibrillation recurrence after catheter ablation: a systematic review and meta-analysis

Stergios Intzes  1 , Konstantinos Zagoridis  1 , Marianthi Symeonidou  1 , Emmanouil Spanoudakis  1 , Arash Arya  2 , Borislav Dinov  2 , Nikolaos Dagres  2 , Gerhard Hindricks  2 , Andreas Bollmann  2 , Emmanuel Kanoupakis  3 , Emmanuel Koutalas  3 , Sotirios Nedios  2
Affiliations
Meta-Analysis

P-wave duration and atrial fibrillation recurrence after catheter ablation: a systematic review and meta-analysis

Stergios Intzes et al. Europace. .

Abstract

Aims: Atrial fibrillation (AF) is a global health problem with high morbidity and mortality. Catheter ablation (CA) can reduce AF burden and symptoms, but AF recurrence (AFr) remains an issue. Simple AFr predictors like P-wave duration (PWD) could help improve AF therapy. This updated meta-analysis reviews the increasing evidence for the association of AFr with PWD and offers practical implications.

Methods and results: Publication databases were systematically searched and cohort studies reporting PWD and/or morphology at baseline and AFr after CA were included. Advanced interatrial block (aIAB) was defined as PWD ≥ 120 ms and biphasic morphology in inferior leads. Random-effects analysis was performed using the Review Manager 5.3 and R programs after study selection, quality assessment, and data extraction, to report odds ratio (OR) and confidence intervals. : Among 4175 patients in 22 studies, 1138 (27%) experienced AFr. Patients with AFr had longer PWD with a mean pooled difference of 7.8 ms (19 studies, P < 0.001). Pooled OR was 2.04 (1.16-3.58) for PWD > 120 ms (13 studies, P = 0.01), 2.42 (1.12-5.21) for PWD > 140 ms (2 studies, P = 0.02), 3.97 (1.79-8.85) for aIAB (5 studies, P < 0.001), and 10.89 (4.53-26.15) for PWD > 150 ms (4 studies, P < 0.001). There was significant heterogeneity but no publication bias detected.

Conclusion: P-wave duration is an independent predictor for AF recurrence after left atrium ablation. The AFr risk is increasing exponentially with PWD prolongation. This could facilitate risk stratification by identifying high-risk patients (aIAB, PWD > 150 ms) and adjusting follow up or interventions.

Keywords: Ablation; Atrial fibrillation; Interatrial block/conduction; P-wave; Recurrence.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Graphical Abstract
Graphical Abstract
P-wave duration (PWD) is an independent predictor for recurrence after atrial fibrillation (AF) ablation. The risk is increasing exponentially with PWD prolongation and the presence of partial (pIAB) or advanced (aIAB) interatrial block. Thus, PW could identify high-risk patients (aIAB, PWD > 150 ms) in order to adjust follow up or interventions.
Figure 1
Figure 1
Flow chart of the study selection process according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. AFr, atrial fibrillation recurrence; PWD, P-wave duration.
Figure 2
Figure 2
Baseline difference (mean ± SD) of PWD in patients with and without atrial fibrillation (AF) recurrence after catheter ablation. The forest plot shows the weighted pooled mean difference and 95%CI of baseline PWD between the two groups.
Figure 3
Figure 3
Subgroup analysis demonstrates the effect of P-wave duration (PWD) for the prediction of atrial fibrillation recurrence (AFr) after catheter ablation in comparison with morphological characterization of advanced interatrial block (aIAB: PWD > 120 ms and biphasic P-wave in inferior leads). (A) Pooled odds ratio for PWD>120 ms. (B) Pooled odds ratio for PWD>140 ms. (C). Pooled odds ratio for aIAB. (D). Pooled odds ratio for PWD>150 ms.
Figure 4
Figure 4
Copas test detected no publication bias with the (A) funnel plot, (B) contour plot, (C) treatment effect plot, or (D) residual selection bias plot.
See this image and copyright information in PMC

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