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. 2025 Mar;68(2):335-346.
doi: 10.1007/s10840-023-01543-7. Epub 2023 Apr 19.

Reduction in atrial and ventricular electrical heterogeneity following pulmonary vein isolation in patients with atrial fibrillation

Guilherme L Fialho  1   2 , Bruce D Nearing  2 , Jonathan W Waks  2 , Timothy R Maher  2 , John-Ross Clarke  2 , Alyssa Shepherd  2 , Andre D'Avila  2 , Richard L Verrier  3
Affiliations

Reduction in atrial and ventricular electrical heterogeneity following pulmonary vein isolation in patients with atrial fibrillation

Guilherme L Fialho et al. J Interv Card Electrophysiol. 2025 Mar.

Abstract

Background: Pulmonary vein isolation (PVI) modulates the intrinsic cardiac autonomic nervous system and reduces atrial fibrillation (AF) recurrence.

Methods: In this retrospective analysis, we investigated the impact of PVI on ECG interlead P-wave, R-wave, and T-wave heterogeneity (PWH, RWH, TWH) in 45 patients in sinus rhythm undergoing clinically indicated PVI for AF. We measured PWH as a marker of atrial electrical dispersion and AF susceptibility and RWH and TWH as markers of ventricular arrhythmia risk along with standard ECG measures.

Results: PVI acutely (16 ± 8.9 h) reduced PWH by 20.7% (from 31 ± 1.9 to 25 ± 1.6 µV, p < 0.001) and TWH by 27% (from 111 ± 7.8 to 81 ± 6.5 µV, p < 0.001). RWH was unchanged after PVI (p = 0.068). In a subgroup of 20 patients with longer follow-up (mean = 47 ± 3.7 days after PVI), PWH remained low (25 ± 1.7 µV, p = 0.01), but TWH partially returned to the pre-ablation level (to 93 ± 10.2, p = 0.16). In three individuals with early recurrence of atrial arrhythmia in the first 3 months after ablation, PWH increased acutely by 8.5%, while in patients without early recurrence, PWH decreased acutely by 22.3% (p = 0.048). PWH was superior to other contemporary P-wave metrics including P-wave axis, dispersion, and duration in predicting early AF recurrence.

Conclusion: The rapid time course of decreased PWH and TWH after PVI suggests a beneficial influence likely mediated via ablation of the intrinsic cardiac nervous system. Acute responses of PWH and TWH to PVI suggest a favorable dual effect on atrial and ventricular electrical stability and could be used to track individual patients' electrical heterogeneity profile.

Keywords: Ablation; Atrial fibrillation recurrence; Electrical dispersion; P-wave heterogeneity; Pulmonary vein isolation; T-wave heterogeneity.

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Conflict of interest statement

Declarations. Ethics approval: This medical records study conformed to requirements laid down in the 1964 Declaration of Helsinki and its amendments and was approved by the institutional review board of BIDMC (Protocol 2003–000420). Patient information was retrospectively obtained and deidentified. Informed consent: The informed consent requirement was waived. Ethical Publication Statement: We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. Permission to reproduce material from other sources: No material from other sources was used. Competing interests: None of the authors declares a financial or non-financial interest relevant to the content of this article.

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