Prolonged P-wave duration is associated with atrial fibrillation recurrence after successful pulmonary vein isolation for paroxysmal atrial fibrillation

Abstract

Pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) is successful in ∼70-80% after repeated procedures. This suggests a subgroup of PAF patients where electrical abnormalities outside the pulmonary veins are important. Prolonged P-wave duration (PWD), a marker of atrial remodelling, may identify this subgroup. This study's aim was to assess the association of PWD on standard 12 lead ECG with AF recurrence post PVI. Retrospectively, ECGs were blindly analysed on PVI patients from August 2007-August 2011; patients with persistent AF, mitral valve disease, undergoing redo procedures or no sinus rhythm (SR) ECG within 1year of PVI were excluded. ECGs were directly uploaded at 300dpi, amplified ×10, and then PWD measured in all leads. Prolonged PWD was as priori defined as maximum PWD ≥ 140ms. The selective cohort consisted of 100 patients out of a total of 170 PVI: age 58 ± 11years, 72% male, LVEF 62 ± 9%, 18% ischaemic heart disease and 13% diabetic. Thirty-five had prolonged PWD, which was associated with greater AF recurrence rates compared to those without prolonged PWD (63 vs. 38%, p < 0.05). Similarly, AF recurrence was associated with greater maximum PWD (139 ± 17 vs. 129 ± 14, p < 0.01), P-wave dispersion (58 ± 21 vs. 49 ± 15, p < 0.01), left atrium (LA) dimension (41 ± 6 vs. 38 ± 5, p < 0.05) and LA volumes (40 ± 14 vs. 34 ± 11, p < 0.05) compared to those who remained in SR. None of these variables were independent predictors of AF recurrence by multivariate analysis. The presence of pre-existent prolonged PWD is associated with a higher risk of AF recurrence post PVI for paroxysmal AF.