The novel P-Wave Area index predicts low voltage areas in patients undergoing pulmonary vein isolation for treatment of atrial fibrillation

Abstract

Abstract Introduction Presence of low voltage areas (LVA) mirrors progression of atrial fibrillation (AF) and is associated with an impaired rhythm outcome after AF ablation. P-wave indices can predict LVA, however accuracy is depending on myocardial mass, therefore the P Wave area was indexed for the left atrial area. The aim of current analysis was to investigate the association between the novel P-Wave Area Index (PWAi) and the presence of LVA. Methods Patients undergoing first AF ablation were included into analysis. LVA were determined using high-density maps and defined as <0.5 mV. All patients underwent CMR imaging (Ingenia 1.5T Philips) and received 12 lead ecg in sinusrhythm before intervention. CMR data (LA area) and P-Wave Area in Leads I ( PWA(I)) and II (PWA(II)) were measured in all patients. Afterwards the P-Wave Area was indexed for LA area to create the PWAi. Results A total of 264 consecutive patients were included in the analysis (65 years, 41% females, 57% persistent AF, 30.6% LVAs). Of all analyzed P-Wave indices, P Wave Area in lead II could effectively identify LVA (AUC: 0.813, p<0.001). In patients with LVA, PWAi below 0.4781 msec*mV*m²/cm² identified patients with LVA with an accuracy of 81% (81% sensitivity, 81% specificity, 65% pos. predictive value and 91% neg. predictive value) and was the strongest predictor among all analyzed parameters (OR: 20,578, AUC; 0.860) Conclusion The PWAi is a highly significant tool to identify potential LVA before AF Ablation. This findings help to further individualize AF treatment.Multivariate AnalysisROC analysis