title: P-wave indices as predictors of atrial fibrillation recurrence after pulmonary vein isolation in normal left atrial size.
abstract: OBJECTIVE
  Prolonged P-wave duration and dispersion are universally accepted noninvasive markers for atrial electrical remodeling. Our aim was to analyze P-wave indices as predictors of atrial fibrillation recurrence after pulmonary vein isolation in patients with normal left atrial size.
  
  
  METHODS
  From January 2008 to December 2011, 426 patients with drug-resistant symptomatic paroxysmal atrial fibrillation underwent pulmonary vein isolation as an index procedure by conventional radiofrequency or cryoballoon ablation in our center. Patients with left atrial dilatation, poor-quality electrocardiograms, atrial pacemaker stimulation, and those undergoing repeat procedures were excluded. A total of 201 patients were analyzed during a mean follow-up of 22 ± 16 months.
  
  
  RESULTS
  Patients with prolonged P-wave duration had higher rates of atrial fibrillation recurrences compared with those without prolonged P-wave duration (49 vs. 14%; P < 0.001). Atrial fibrillation recurrence was significantly associated with prolonged P-wave duration (129 ± 13 vs. 119 ± 11 ms; P < 0.001) and P-wave dispersion (54 ± 12 vs. 42 ± 10 ms; P < 0.001) compared with those who remained in sinus rhythm. P-wave duration and dispersion were independently associated with atrial fibrillation recurrence (hazard ratio 1.045, 95% confidence interval 1.027-1.063, P < 0.001; and hazard ratio 1.049, 95% confidence interval 1.022-1.078, P < 0.001, respectively), after adjusting for left atrial size and age.
  
  
  CONCLUSIONS
  Prolonged P-wave duration and dispersion were found to be independently associated with higher recurrence rates of atrial fibrillation after pulmonary vein isolation in patients with normal left atrial dimension. Therefore, a prolongation of P-wave indices may help to identify those patients in whom electrical remodeling has already occurred and a more extensive ablation may be indicated.
authors.affiliation: aHeart Rhythm Management Centre, UZ Brussel-VUB, Brussels, BelgiumbDepartment of Cardiology, University Hospital of Verona, Verona, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Mugnai
authors.forename: Gian-Battista
authors.initials: GB
authors.lastname: Chierchia
authors.forename: Carlo
authors.initials: C
authors.lastname: de Asmundis
authors.forename: Justo
authors.initials: J
authors.lastname: Juliá
authors.forename: Giulio
authors.initials: G
authors.lastname: Conte
authors.forename: Juan
authors.initials: J
authors.lastname: Sieira-Moret
authors.forename: Lucio
authors.initials: L
authors.lastname: Capulzini
authors.forename: Kristel
authors.initials: K
authors.lastname: Wauters
authors.forename: Moises
authors.initials: M
authors.lastname: Rodriguez-Mañero
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ciconte
authors.forename: Giannis
authors.initials: G
authors.lastname: Baltogiannis
authors.forename: Giacomo
authors.initials: G
authors.lastname: Di Giovanni
authors.forename: Yukio
authors.initials: Y
authors.lastname: Saitoh
authors.forename: Pedro
authors.initials: P
authors.lastname: Brugada
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery; D017115:Catheter Ablation; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies