Post-ablation P wave characteristics correlate with recurrent atrial fibrillation in the ABCD-AF cohort

• Published in: Journal of interventional cardiac electrophysiology Vol. 64; no. 2; pp. 437 - 442
• Main Authors: Supanekar, Neil, Gilge, Jasen L., Ahmed, Asim, Patel, Parin J.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.08.2022; Springer Nature B.V
• Subjects: Ablation; Cardiac arrhythmia; Cardiology; Elastic waves; Fibrillation; Lead; Medicine; Medicine & Public Health; Morbidity; P waves; Parameters; Electrocardiography; Atrial fibrillation catheter ablation
• ISSN: 1383-875X; 1572-8595; 1572-8595
• DOI: 10.1007/s10840-021-01049-0

Purpose Atrial fibrillation (AF) ablation is a common procedure to reduce cardiovascular morbidity but is limited by recurrence. The objective of this study was to determine if post-ablation acute surface P wave morphology and other electrocardiographic parameters correlate with AF recurrence. Methods The Avoiding Bladder Catheters During AF ablation (ABCD-AF) trial was a randomized, prospective trial in 160 subjects undergoing AF ablation. The present study examined correlation between AF recurrence in follow-up and acute post-ablation electrocardiographic P wave parameters. Results Median follow-up was 255 (188, 306) days. The ABCD-AF cohort had a mean age of 62.7 ± 12.8 with 32.1% being females. Rate of recurrent AF was 35.8%, with a median time to AF of 135 (109, 182) days. There was no baseline demographic associated with AF recurrence. There was more AF recurrence in those with longer follow-up ( p  = 0.001). Lead 2 PR interval, lead 2 P wave duration/PR (Pdur/PR), lead V1 PR interval, and lead V1 Pdur/PR were all significantly associated with recurrent AF ( p  = 0.03, 0.02, 0.01, 0.01). Longer PR and shorter Pdur/PR predicted AF recurrence. In a multivariable model, lead V1 Pdur/PR provided the best predictor of AF recurrence, with an odds ratio of 0.018 ( p  = 0.016) per standard deviation change. Conclusions Shorter P wave duration combined with longer AV node delay, as measured by proportion of the PR that the P wave occupies, was the best predictor of AF recurrence post-ablation.