title: Change in P wave morphology after convergent atrial fibrillation ablation.
abstract: Convergent atrial fibrillation ablation involves extensive epicardial as well as endocardial ablation of the left atrium. We examined whether it changes the morphology of the surface P wave. We reviewed electrocardiograms of 29 patients who underwent convergent ablation for atrial fibrillation. In leads V1, II and III, we measured P wave duration, area and amplitude before ablation, and at 1, 3 and 6 months from ablation. After ablation, there were no significant changes in P wave amplitude, area, or duration in leads II and III. There was a significant reduction in the area of the terminal negative deflection of the P wave in V1 from 0.38 mm(2) to 0.13 mm(2) (p = 0.03). There is also an acute increase in the amplitude and duration of the positive component of the P wave in V1 followed by a reduction in both by 6 months. Before ablation, 62.5% of the patients had biphasic P waves in V1. In 6 months, only 39.2% of them had biphasic P waves. Hybrid ablation causes a reduction of the terminal negative deflection of the P wave in V1 as well as temporal changes in the duration and amplitude of the positive component of the P wave in V1. This likely reflects the reduced electrical contribution of the posterior left atrium after ablation as well as anatomical and autonomic remodeling. Recognition of this altered sinus P wave morphology is useful in the diagnosis of atrial arrhythmias in this patient population.
authors.affiliation: Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, USA. Electronic address: sshrestha@maimonidesmed.org.
authors.forename: Suvash
authors.initials: S
authors.lastname: Shrestha
authors.affiliation: Department of Cardiology, Maimonides Medical Center, Brooklyn, NY, USA. Electronic address: ochen@maimonidesmed.org.
authors.forename: On
authors.initials: O
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Maimonides Medical Center, Brooklyn, NY, USA. Electronic address: MAgreene@maimonidesmed.org.
authors.forename: Mary
authors.initials: M
authors.lastname: Greene
authors.affiliation: Department of Cardiology, Maimonides Medical Center, Brooklyn, NY, USA; William Beaumont Hospital, Royal Oak, MI, USA. Electronic address: Jjohn3@maimonidesmed.org.
authors.forename: Jinu Jacob
authors.initials: JJ
authors.lastname: John
authors.affiliation: Department of Cardiac-electrophysiology, Maimonides Medical Center, Brooklyn, NY, USA. Electronic address: ygreenberg@maimonidesmed.org.
authors.forename: Yisachar
authors.initials: Y
authors.lastname: Greenberg
authors.affiliation: Department of Cardiac-electrophysiology, Maimonides Medical Center, Brooklyn, NY, USA. Electronic address: fyang@maimonidesmed.org.
authors.forename: Felix
authors.initials: F
authors.lastname: Yang
keywords: Atrial fibrillation; Convergent ablation; P wave area; P wave duration