Impact of pulmonary vein isolation on atrial late potentials: association with the recurrence of atrial fibrillation.
OBJECTIVE
In patients with paroxysmal atrial fibrillation (AF), the P-wave signal-averaged electrocardiogram often demonstrates a low-amplitude potential at the terminal part of filtered P-wave (atrial late potential: ALP), which would originate from delayed pulmonary vein (PV) potentials. The aim of this study was to investigate the impact of PV isolation on P-wave morphology, and explore the association between ALP and AF recurrence after ablation.


RESULTS
We enrolled 88 consecutive paroxysmal AF patients scheduled for ablation. The signal-averaged electrocardiogram was obtained at baseline and 1 day after ablation. An ALP was defined as a P-wave duration of ≥ 130 ms and a root-mean-squared voltage of the terminal 20 ms of ≤ 2.0 μV. A pre-procedural ALP was found in 37 (42%) patients and a post-procedural ALP was found in 26 (30%) patients. We completed PV isolation in all patients and followed them for 16 ± 4 months. The AF recurrence rate was 30% (26 patients) and was similar between patients with and without pre-procedural ALP (27 vs. 31%, respectively, P = 0.66); however, AF recurrence was significantly higher in patients with than without post-procedural ALP (54 vs. 19%, respectively, P = 0.001). In multivariate logistic regression analysis, post-procedural ALP was independently associated with AF recurrence (odds ratio = 4.22, 95% confidence interval = 1.52-11.7).


CONCLUSIONS
Pulmonary vein isolation can modify ALP in a substantial number of patients with paroxysmal AF. Post-procedural ALP is associated with increased risk of future AF recurrence.
Cardiovascular Center, Sakurabashi Watanabe Hospital, 2-4-32, Umeda, Osaka 530-0001, Japan.
Masaharu
M
Masuda
Koichi
K
Inoue
Katsuomi
K
Iwakura
Atsunori
A
Okamura
Yuko
Y
Toyoshima
Atsushi
A
Doi
Yohei
Y
Sotomi
Issei
I
Komuro
Kenshi
K
Fujii
D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016275:Atrial Function; D017115:Catheter Ablation / Q000009:adverse effects; D018572:Disease-Free Survival; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome