A new use for an old technique?

Abstract

This editorial refers to ‘Changes in P-wave area and P-wave duration after circumferential pulmonary vein isolation’ by K. Van Beeumen et al ., on page 798. Since Brodie first performed high-resolution recordings of the surface P-wave, using signal averaging, more than 40 years ago numerous publications have attempted to establish a clinical use for this technique. Initial case–control studies established that individuals known to have paroxysmal atrial fibrillation (PAF) have a longer P-wave duration and a higher P-wave energy than controls.1 This has lead to exploration of this technique as a predictor of atrial fibrillation (AF) occurrence in populations judged to be at risk or in individuals following intervention for episodes of arrhythmia. Hence, the utility of the signal averaged P-wave as a predictor of AF in a variety of clinical settings has been investigated.2 In general, these and other studies have identified that, in whatever scenario, patients that are likely to develop AF have longer P-waves, increased P-wave energy (or amplitude) and increased P-wave dispersion. Similar findings are apparent when the risk of recurrent AF after cardioversion or after cardioversion from short- or long-term AF are studied.3,4 Despite the above investigations, the signal averaged P-wave remains largely a research tool with limited clinical use. This is likely to relate to the nature of AF itself and of the therapies available for its treatment. …