title: Prediction of the efficacy of pulmonary vein isolation for the treatment of atrial fibrillation by the signal-averaged P-wave duration.
abstract: BACKGROUND
  The noninvasive methods for predicting a successful pulmonary vein isolation (PVI) have not been well described. The aim of this study was to assess the usefulness of the P-wave signal-averaged electrocardiogram (P-SAECG) in predicting the chance of a successful PVI in patients with atrial fibrillation (AF).
  
  
  METHODS
  A P-SAECG was recorded before (pre), 1 day after, and 3-4 months after the PVI in 51 AF patients (41, paroxysmal AF; 10, persistent AF). Three-dimensional electroanatomic mapping (3D-EAM) of the right and left atria and left PVs was performed before PVI in 10 patients to analyze the biatrial conduction time (BAT).
  
  
  RESULTS
  Fifteen patients suffered from AF recurrences 3 months or more after the PVI. The pre-filtered P-wave duration (FPD) was significantly longer in patients with recurrence than in those without (166.8 +/- 14.8 ms vs 145.9 +/- 12.6 ms, P < 0.0001). In both patient groups, PVI shortened the FPD, which continued for 3-4 months. Multivariate analysis revealed that a pre-FPD >150 ms was a powerful predictor for recurrence, but persistent AF, the left atrial dimension, and structural heart disease were not predictors for recurrence. 3D-EAM showed that the delayed activation point was located within the left PVs and the BAT was identical to the pre-FPD.
  
  
  CONCLUSIONS
  The pre-FPD may strongly reflect atrial dysfunction, and thus may be useful for predicting a successful PVI. Shortening of the FPD after the PVI and similar FPD and BAT values suggest that the last component of the FPD represents the activation of the left PVs.
authors: Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan. yasuwook@yahoo.co.jp
authors: Yasuo
authors: Y
authors: Okumura
authors: Ichiro
authors: I
authors: Watanabe
authors: Kimie
authors: K
authors: Ohkubo
authors: Sonoko
authors: S
authors: Ashino
authors: Masayoshi
authors: M
authors: Kofune
authors: Kenichi
authors: K
authors: Hashimoto
authors: Atsushi
authors: A
authors: Shindo
authors: Hidezou
authors: H
authors: Sugimura
authors: Toshiko
authors: T
authors: Nakai
authors: Yuji
authors: Y
authors: Kasamaki
authors: Satoshi
authors: S
authors: Saito
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011667:Pulmonary Veins / Q000601:surgery*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome