Maximum P-wave duration and P-wave dispersion predict recurrence of paroxysmal atrial fibrillation in patients with Wolff-Parkinson-White syndrome after successful radiofrequency catheter ablation.
BACKGROUND
Identification of patients at risk for PAF recurrence after AP ablation is important because of the necessity for additional therapies.


OBJECTIVE
To determine whether Maximum P-wave duration (Pmax) and P-wave dispersion (Pd ) detected on surface ECG after successful accessory pathway (AP) ablation can predict the recurrence of paroxysmal atrial fibrillation (PAF).


METHODS
Seventy-eight patients with Wolff-Parkinson-White (WPW) syndrome who had at least one documented PAF episode and underwent catheter ablation were enrolled. Pmax, minimum P-wave duration (Pmin) and Pd were determined on a surface ECG recorded on a high resolution computer screen on day 2 after ablation of the AP.


RESULTS
There was no significant difference in terms of basic clinical data and electrophysiological findings between patients with (Group-1, n = 19) and without (Group-2, n = 59) recurrence of PAF during follow-up of 21 +/- 10 months. Pmax and Pd were significantly higher in Group-1 than Group-2 (120 +/- 15 vs. 96 +/- 10 ms and 47 +/- 12 vs. 25 +/- 7 ms, respectively; p < 0.001 for both). Pmin didn't differ significantly. A Pmax value of > or = 103 ms separated Group-1 from Group-2 with a sensitivity of 84.2%, specificity of 72.9%, positive predictive value of 50%, and negative predictive value of 93.5%. A Pd value of > or = 32.5 ms separated Group-1 from Group-2 with a sensitivity of 89.5%, specificity of 84.7%, positive predictive value of 65.4%, and negative predictive value of 96.2%. Pmax (p < 0.010) and Pd (p < 0.001) were found to be significant univariate predictors of PAF, whereas only Pd remained significant in multivariate analysis (p = 0.037).


CONCLUSIONS
Pd > or = 32.5 ms and Pmax > or = 103.0 ms predict the recurrence of PAF after ablation with acceptable positive and negative predictive values. Pd > or = 32.5 ms is an independent predictor of recurrence of PAF after catheter ablation in patients with WPW syndrome.
Hacettepe University Faculty of Medicine, Ankara, Turkey.
Kudret
K
Aytemir
Basri
B
Amasyali
Sedat
S
Kose
Ayhan
A
Kilic
Gulcan
G
Abali
Ali
A
Oto
Ersoy
E
Isik
D000293:Adolescent; D000328:Adult; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology*; D017115:Catheter Ablation; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012008:Recurrence; D012107:Research Design; D012680:Sensitivity and Specificity; D014927:Wolff-Parkinson-White Syndrome / Q000503:physiopathology / Q000601:surgery*