title: P wave signal-averaged electrocardiography predicts recurrence of paroxysmal atrial fibrillation in patients with Wolff-Parkinson-White syndrome who underwent successful catheter ablation: a prospective study.
abstract: BACKGROUND
  Paroxysmal atrial fibrillation (PAF) frequently occurs in patients with Wolff-Parkinson-White (WPW) syndrome. Catheter ablation of the accessory pathway eliminates PAF in some patients, but PAF frequently recurs in other patients. The present study was designed to determine prospectively whether P wave signal-averaged electrocardiography (P-SAECG) predicts the recurrence of PAF after successful ablation in patients with WPW syndrome.
  
  
  RESULTS
  Forty-six patients with WPW syndrome who had episodes of PAF were prospectively followed. SAECG recording was performed on day 7 after successful ablation of the accessory pathway at study entry. Abnormal P-SAECG for the prediction of recurrence of PAF was defined as a filtered P wave duration > 130 msec. Eleven patients had an abnormal P-SAECG (group 1), whereas 35 patients (group 2) did not. The two groups did not differ in terms of gender, age, left atrial dimension, and atrial vulnerability as determined by electrophysiologic study. During follow-up (40 +/- 19 months), the recurrence of PAF was noted in 10 (91%) of 11 patients in group 1, whereas it was observed in only 2 (6%) of 35 patients in group 2. Kaplan-Meier analysis revealed that the recurrence of PAF was significantly more frequent in group 1 than in group 2 (log rank test, P < 0.0001). By multivariate analysis, filtered P wave duration >130 msec was an independent predictor of recurrence of PAF after ablation (Chi-square = 21.5, P < 0.0001).
  
  
  CONCLUSIONS
  The results of this study indicate that P-SAECG may be useful for identifying patients at risk for recurrence of PAF after successful ablation of WPW syndrome.
authors.affiliation: Department of Internal Medicine III and the Cardiovascular Research Institute, Kurume University School of Medicine, Japan. thiraki@med.kurume-u.ac.jp
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Hiraki
authors.forename: Hisao
authors.initials: H
authors.lastname: Ikeda
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Yoshida
authors.forename: Tomohito
authors.initials: T
authors.lastname: Inage
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Ohe
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ohtsubo
authors.forename: Manabu
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Hamada
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kubara
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Imaizumi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D017115:Catheter Ablation; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014927:Wolff-Parkinson-White Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*