title: Changes in P-wave area and P-wave duration after circumferential pulmonary vein isolation.
abstract: OBJECTIVE
  The effect of circumferential pulmonary vein isolation (CPVI) on P-wave characteristics is not clear. We used the signal-averaged (SA) electrocardiogram (ECG) and the ECG derived vector cardiogram (dVCG) to study the influence of CPVI on P-wave duration (PWD) and P-wave area (PWA) and studied whether changes were associated with successful outcome after initial CPVI.
  
  
  RESULTS
  Thirty-nine patients (56 +/- 10 years, 72% males) underwent CPVI for paroxysmal or persistent atrial fibrillation (AF). For each patient, an ECG recording was taken at the start and end of the ablation procedure. dVCG was derived using the inverse Dower transform. PWD was defined by manual annotation of earliest onset and latest offset of the SA-P-wave. PWA was calculated as the area under the SA-ECG curve averaged for the 12 ECG leads (PWA-ECG) and SA-dVCG curve (PWA-dVCG). Successful outcome after CPVI was defined as freedom from symptomatic and asymptomatic AF at the end of follow-up (11 +/- 5 months). Average PWD decreased from 132 +/- 14 to 126 +/- 16 ms (P < 0.01). PWA-ECG and PWA-dVCG decreased markedly from 4.64 +/- 1.40 to 3.65 +/- 1.61 mVms (P < 0.001) and from 4.27 +/- 1.66 to 2.48 +/- 1.59 mVms (P < 0.001). Parameters of PWA were not different between successes (n = 31) and failures (n = 8). In contrast, PWD after ablation was significantly shorter in patients with successful outcome (123 +/- 16 vs. 135 +/- 11 ms, P < 0.05).
  
  
  CONCLUSIONS
  (i) CPVI results in a modest but significant shortening in PWD and a marked decrease in PWA. (ii) PWD was significantly shorter in cases of successful outcome after CPVI.
authors.affiliation: Department of Cardiology, University Hospital, Ghent, Belgium. katarina.vanbeeumen@azstlucas.be
authors.forename: Katarina
authors.initials: K
authors.lastname: Van Beeumen
authors.forename: Richard
authors.initials: R
authors.lastname: Houben
authors.forename: Rene
authors.initials: R
authors.lastname: Tavernier
authors.forename: Stefan
authors.initials: S
authors.lastname: Ketels
authors.forename: Mattias
authors.initials: M
authors.lastname: Duytschaever
mesh_terms: D000368:Aged; D000465:Algorithms; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D016279:Atrial Function, Left / Q000502:physiology; D017115:Catheter Ablation; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000502:physiology; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000502:physiology*; D013812:Therapeutics; D014672:Vectorcardiography / Q000379:methods