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. 2024 May 2;40(3):472-478.
doi: 10.1002/joa3.13050. eCollection 2024 Jun.

Notched P-wave on digital electrocardiogram predicts the recurrence of atrial fibrillation in patients who have undergone catheter ablation

Takafumi Okuyama  1 , Tomoyuki Kabutoya  1 , Kazuomi Kario  1
Affiliations

Notched P-wave on digital electrocardiogram predicts the recurrence of atrial fibrillation in patients who have undergone catheter ablation

Takafumi Okuyama et al. J Arrhythm. .

Abstract

Background: A notched P-wave is associated with the occurrence of atrial fibrillation (AF). However, the association between a notched P-wave and AF recurrence in patients who have undergone a catheter ablation for AF is unclear.

Methods: We enrolled 100 subjects who underwent catheter ablation for AF (paroxysmal AF: 60 cases; persistent AF: 40 cases). Twelve-lead electrocardiography (ECG) was conducted, and the peak-to-peak distance in the M shape was calculated automatically using a 12-lead ECG analysis system. A notched P-wave was defined as a P-wave with an M-shape and a peak-to-peak distance of ≥20 ms in lead II. We compared the recurrence of AF in the patients with notched P-wave and the others.

Results: The mean follow-up period was 12 ± 8 months, and a recurrence of AF was observed in 28 patients. The recurrence of AF in the notched P-wave group was significantly higher than that in the controls (log rank 5.14, p = .023). A notched P-wave was a significant predictor of the recurrence of AF after adjustment for age, gender, history of heart failure, history of catheter ablation, persistent AF, use of antiarrhythmic drugs, and the left atrial volume index (hazard ratio 2.470, 95% confidence interval 1.065-5.728, p = .035).

Conclusions: Automatically identified notched P-waves with peak-to-peak distance ≥20 ms were associated with AF recurrence in patients who had undergone catheter ablation.

Keywords: P wave; atrial fibrillation; catheter ablation; electrocardiogram; prognosis.

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Conflict of interest statement

TK reports research and education support from Medtronic, Japan Lifeline, and Abbott. KK reports lecture fees from Omron Healthcare and A&D; funded research or joint research expenses from Omron Healthcare and Fukuda Denshi outside the submitted work.

Figures

FIGURE 1
FIGURE 1
The measurements of notch interval and definition of a notched P‐wave.
FIGURE 2
FIGURE 2
Event‐free survival in patients with and without notched P‐waves.
FIGURE 3
FIGURE 3
Event‐free survival in patients with and without notched P‐waves. (A) The patients with paroxysmal AF. (B) The patients with persistent AF. AF, atrial fibrillation.
FIGURE 4
FIGURE 4
Event‐free survival in patients with and without a P‐wave duration in lead II of ≥108 ms.
See this image and copyright information in PMC

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