title: Novel non-invasive P wave analysis for the prediction of paroxysmal atrial fibrillation recurrences in patients without structural heart disease: a prospective pilot study.
abstract: OBJECTIVE
  The pathogenetic mechanisms responsible for the initiation and recurrence of PAF are not fully elucidated and vary among individuals. We evaluated the ability of a novel non-invasive approach based on P wave wavelet analysis to predict symptomatic paroxysmal atrial fibrillation (PAF) recurrences in individuals without structural heart disease.
  
  
  METHODS
  We studied 50 patients (24 males, mean age 54.9 ± 9.8 years) presented to our emergency department with a symptomatic episode of PAF. The patients were followed-up for 12.1 ± 0.1 months and classified into two groups according to the number of PAF episodes: Group A (<5 PAF, n = 33), Group B (≥ 5 PAF, n = 17). A third Group of 50 healthy individuals without history of PAF was used as control. Study groups underwent echocardiography and orthogonal ECG-based wavelet analyses of P waves at baseline and follow-up. Maximum and mean P wave energies were calculated in each subject at each orthogonal lead using the Morlet wavelet analysis.
  
  
  RESULTS
  Larger P wave energies at X lead and relatively larger left atrium were independently associated with >5 PAF episodes vs. <5 PAF episodes. No difference in P wave duration was detected between Groups A and B (p > 0.1), whereas Group A and B patients had longer P waves at Z lead compared to Group C (86.4 ± 13 vs. 71.5 ± 15 msec, p < 0.001).
  
  
  CONCLUSIONS
  P wave wavelet analysis can reliably predict the generation and recurrence of PAF within a year. P wave wavelet analysis could contribute to the early identification of patients at risk for increased number of PAF recurrences.
authors.affiliation: 1st Cardiology Department, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece.
authors.forename: Vassilios
authors.initials: V
authors.lastname: Vassilikos
authors.forename: George
authors.initials: G
authors.lastname: Dakos
authors.forename: Yiannis S
authors.initials: YS
authors.lastname: Chatzizisis
authors.forename: Ioanna
authors.initials: I
authors.lastname: Chouvarda
authors.forename: Charalambos
authors.initials: C
authors.lastname: Karvounis
authors.forename: Charles
authors.initials: C
authors.lastname: Maynard
authors.forename: Nicos
authors.initials: N
authors.lastname: Maglaveras
authors.forename: Stylianos
authors.initials: S
authors.lastname: Paraskevaidis
authors.forename: George
authors.initials: G
authors.lastname: Stavropoulos
authors.forename: Charalambos I
authors.initials: CI
authors.lastname: Styliadis
authors.forename: Sotirios
authors.initials: S
authors.lastname: Mochlas
authors.forename: Ioannis
authors.initials: I
authors.lastname: Styliadis
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D004452:Echocardiography / Q000379:methods / Q000639:trends; D004562:Electrocardiography / Q000379:methods* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence