title: Variability of P-wave morphology predicts the outcome of circumferential pulmonary vein isolation in patients with recurrent atrial fibrillation.
abstract: BACKGROUND
  Severe atrial structural remodeling may reflect irreversible damage of the atrial tissue in patients with atrial fibrillation (AF) and is associated with changes of P-wave duration and morphology. Our aim was to study whether variability of P-wave morphology (PMV) is associated with outcome in patients with AF after circumferential PV isolation (CPVI).
  
  
  RESULTS
  70 consecutive patients (aged 60±9years, 46 men) undergoing CPVI due to symptomatic AF were studied. After cessation of antiarrhythmic therapy, standard 12-lead ECG during sinus rhythm was recorded for 10min at baseline and transformed to orthogonal leads. Beat-to-beat P-wave morphology was subsequently defined using a pre-defined classification algorithm. The most commonly observed P-wave morphology in a patient was defined as the dominant morphology. PMV was defined as the percentage of P waves with non-dominant morphology in the 10-min sample. At the end of follow-up, 53 of 70 patients had no arrhythmia recurrence. PMV was greater in patients without recurrence (19.5±17.1% vs. 8.2±6.7%, p<0.001). In the multivariate logistic regression model, PMV≥20% (upper tertile) was the only independent predictor of ablation success (OR=11.4, 95% CI 1.4-92.1, p=0.023). A PMV≥20% demonstrated a sensitivity of 41.5%, a specificity of 94.1%, a PPV of 96.7%, and an NPV of 34.0% for free of AF after CPVI.
  
  
  CONCLUSIONS
  We report a significant association between increased PMV and 6-month CPVI success. PMV may help to identify patients with very high likelihood of freedom of AF 6-months after CPVI.
authors.affiliation: Department of Cardiology and Center for Integrative Electrocardiology at Lund University (CIEL), Lund University, Lund, Sweden; Department of Electrophysiology, Heart Center-University Dresden, Dresden, Germany. Electronic address: dr.huoyan@googlemail.com.
authors.forename: Yan
authors.initials: Y
authors.lastname: Huo
authors.affiliation: Department of Cardiology and Center for Integrative Electrocardiology at Lund University (CIEL), Lund University, Lund, Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Holmqvist
authors.affiliation: Department of Cardiology and Center for Integrative Electrocardiology at Lund University (CIEL), Lund University, Lund, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Carlson
authors.affiliation: Department of Electrophysiology, Heart Center-University Dresden, Dresden, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gaspar
authors.affiliation: Department of Electrophysiology, Heart Center-University Leipzig, Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
authors.affiliation: Department of Electrophysiology, Heart Center-University Dresden, Dresden, Germany.
authors.forename: Christopher
authors.initials: C
authors.lastname: Piorkowski
authors.affiliation: Department of Electrophysiology, Heart Center-University Leipzig, Leipzig, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Bollmann
authors.affiliation: Department of Cardiology and Center for Integrative Electrocardiology at Lund University (CIEL), Lund University, Lund, Sweden.
authors.forename: Pyotr G
authors.initials: PG
authors.lastname: Platonov
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D016896:Treatment Outcome
keywords: Atrial fibrillation; Circumferential PV isolation; P-wave morphology; Variability of P-wave morphology