Prediction of the efficacy of pulmonary vein isolation for the treatment of atrial fibrillation by the signal-averaged P-wave duration.
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.
Okumura
Yasuo
Y
Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan. yasuwook@yahoo.co.jp
Watanabe
Ichiro
I
Ohkubo
Kimie
K
Ashino
Sonoko
S
Kofune
Masayoshi
M
Hashimoto
Kenichi
K
Shindo
Atsushi
A
Sugimura
Hidezou
H
Nakai
Toshiko
T
Kasamaki
Yuji
Y
Saito
Satoshi
S
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