An Effective Novel Index for Predicting the Recurrence of Atrial Fibrillation Ablation: P Wave Duration-to-Amplitude Ratio

OBJECTIVE
Atrial fibrillation is the most common arrhythmia observed in the clinical practice. Pulmonary vein isolation is a well established treatment option for atrial fibrillation but is limited by recurrence. Previous studies have demonstrated that abnormal P wave indices were associated with adverse atrial remodeling and its role in predicting atrial fibrillation recurrence. In the present study, we aimed to evaluate the place of a novel index as we named P wave duration-t o-amplitude ratio in predicting the recurrence of atrial fibrillation.


METHODS
Patients who underwent pulmonary vein isolation for symptomatic drug-resistant atrial fibrillation between January 2016 and March 2018 were retrospectively screened. A total of 111 patients were enrolled in the current study. P wave indices of the patients were calculated by precisely measuring the electrocardiogram traces recorded with an electrophysiology recording system.


RESULTS
While P wave duration (129 ± 18.4 vs. 109 ± 15.7 ms, P <.001), P wave duration-to-amplitude ratio (1072.7 ± 528.3 vs. 626.9 ± 368 ms/mV, P <.001), P wave peak time (65 ± 12 vs. 54 ± 10 ms, P <.001), and P wave dispersion (49 ± 14.1 vs. 27.9 ± 17 ms, P =.001) values were significantly higher in the atrial fibrillation recurrence (+) group, the P wave amplitude (0.12 ± 0.05 vs. 0.18 ± 0.02 mV, P <.001) value was found to be lower. A P wave duration-t o-amplitude ratio value of >830 ms/mV has 61.8% sensitivity and 88.4% specificity for the prediction of the atrial fibrillation recurrence (area of under the curve [AUC], 0.727).


CONCLUSION
P wave duration-to-amplitude ratio, which may be considered as an indicator of the temporal and electrical propagation of the P wave in the atria, can predict atrial fibrillation ablation recurrence.