Factors Predicting the Maintenance of Sinus Rhythm by Pulmonary Vein Isolation Alone in Persistent Atrial Fibrillation

Insights from Post-Ablation P-Wave Morphology

Abstract

Persistent atrial fibrillation (PerAF) still exhibits less favorable outcomes post-ablation and the efficacy of linear or substrate ablation in addition to pulmonary vein isolation (PVI) remains controversial. The relationship between P-wave morphology and the maintenance of sinus rhythm in PerAF patients who underwent PVI alone remains unknown.

PerAF patients who underwent PVI alone were enrolled. Pvm (mV) was calculated by the square root of the sum of the squared P-wave amplitude in leads II and V6 and one-half of the P-wave amplitudes in V2 in 12-lead electrocardiograms 48 hours post-ablation were analyzed. Pd/Pvm was the ratio of the P-wave duration (ms) to the Pvm. We divided the patients into 2 groups; high and low Pd/Pvm. The cut-off value of the Pd/Pvm was calculated by receiver operating characteristic analysis. The difference in late recurrence of atrial fibrillation (LRAF) between the 2 groups and the relationship between Pd/Pvm and relevant factors were evaluated.

This study population included a total of 451 PerAF patients. The optimal cut-off value for predicting the LRAF was Pd/Pvm = 812.8 ms/mV (AUC = 0.91, sensitivity = 84.6% and specificity = 84.2%). The median follow-up duration was 726 days. LRAF occurred in 169 patients (37.5%). Cox proportional hazards analysis showed that Pd/Pvm was significantly associated with LRAF (P < 0.001). A multiple regression analysis showed that no hypertension, hemoglobin ≥ 14.1 g/dL, and LA diameter < 47 mm were significantly and independently associated with low Pd/Pvm (P = 0.045, P < 0.001 and P = 0.024, respectively).

Pd/Pvm post-ablation was a useful marker for predicting the maintenance of sinus rhythm after PVI alone in PerAF patients.