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Antoun I, Li X, Kotb AI, Vali Z, Abdelrazik A, Koya A, Mavilakandy A, Koev I, Nizam A, Eldeeb H, Somani R, Ng A. The Role of P Wave Parameters in Predicting Pulmonary Vein Isolation Outcomes for Paroxysmal Atrial Fibrillation: An Observational Cohort Study. J Cardiovasc Dev Dis 2024; 11:277. [PMID: 39330335 PMCID: PMC11431974 DOI: 10.3390/jcdd11090277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 08/28/2024] [Accepted: 09/03/2024] [Indexed: 09/28/2024] Open
Abstract
BACKGROUND Pulmonary vein isolation (PVI) is an effective management method for paroxysmal atrial fibrillation (PAF). The P wave in the 12-lead electrocardiogram (ECG) represents atrial depolarisation. This study aims to utilise the P wave to predict PVI outcomes for PAF. METHODS This single-centre retrospective study aimed to predict PVI outcomes using P wave parameters. It included 211 consecutive patients with first PVI for PAF between 2018 and 2019 and targeted the pulmonary veins (PVs). Procedure success was defined by freedom of ECG-documented AF at 12 months. Digital 12-lead ECGs with 1-50 hertz bandpass filters were monitored before the procedure. Corrected P wave duration (PWDc), P wave amplitude (PWV), P wave dispersion (PWDisp), intra-atrial block (IAB), P wave area (PWA), and P wave terminal force in V1 (PTFV1) were measured before ablation and correlated with the outcomes. RESULTS Successful PVI occurred in 154 patients (73%). Demographics were similar between both arms. P wave parameters correlated with PVI failure included increased PWDc in all leads except for lead III, aVR, and V3, decreased PWV in lead I (hazard ratio [HR]: 0.7, 95% confidence interval [CI]: 0.53-0.95), lead II (HR: 0.45, 95% CI: 0.22-0.65), aVL (HR: 0.58, 95% CI: 0.22-0.98), and aVF (HR: 0.67, 95% CI: 0.58-0.87), decreased PWA in lead I (HR: 0.55, 95% CI: 0.21-0.76), lead II (HR: 0.48, 95% CI: 0.34-0.87), aVL (HR: 0.65, 95% CI: 0.45-0.96), and aVF (HR: 0.61, 95% CI: 0.32-0.89), and the presence of IAB (HR: 2, 95% CI: 1.4-4.2, p = 0.02). PWDisp and PTFV1 were not correlated with PVI outcome. CONCLUSIONS PWDc, PWA, PWV, and IAB are valuable predictors for PVI outcome for PAF at 12 months.
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Affiliation(s)
- Ibrahim Antoun
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Xin Li
- Department of Engineering, University of Leicester, Leicester LE1 7RH, UK
| | - Ahmed I Kotb
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Zakkariya Vali
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, UK
- Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Ahmed Abdelrazik
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Abdulmalik Koya
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Akash Mavilakandy
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Ivelin Koev
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Ali Nizam
- Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Hany Eldeeb
- Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester LE3 9QP, UK
| | - Riyaz Somani
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, UK
- Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester LE3 9QP, UK
| | - André Ng
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, UK
- Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester LE3 9QP, UK
- National Institute for Health Biomedical Centre, Leicester LE3 9QP, UK
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Vraka A, Moreno-Arribas J, Gracia-Baena JM, Hornero F, Alcaraz R, Rieta JJ. The Relevance of Heart Rate Fluctuation When Evaluating Atrial Substrate Electrical Features in Catheter Ablation of Paroxysmal Atrial Fibrillation. J Cardiovasc Dev Dis 2022; 9:176. [PMID: 35735805 PMCID: PMC9224671 DOI: 10.3390/jcdd9060176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 12/10/2022] Open
Abstract
Coronary sinus (CS) catheterization is critical during catheter ablation (CA) of atrial fibrillation (AF). However, the association of CS electrical activity with atrial substrate modification has been barely investigated and mostly limited to analyses during AF. In sinus rhythm (SR), atrial substrate modification is principally assessed at a global level through P-wave analysis. Cross-correlating CS electrograms (EGMs) and P-waves’ features could potentiate the understanding of AF mechanisms. Five-minute surface lead II and bipolar CS recordings before, during, and after CA were acquired from 40 paroxysmal AF patients. Features related to duration, amplitude, and heart-rate variability of atrial activations were evaluated. Heart-rate adjustment (HRA) was applied. Correlations between each P-wave and CS local activation wave (LAW) feature were computed with cross-quadratic sample entropy (CQSE), Pearson correlation (PC), and linear regression (LR) with 10-fold cross-validation. The effect of CA between different ablation steps was compared with PC. Linear correlations: poor to mediocre before HRA for analysis at each P-wave/LAW (PC: max. +18.36%, p = 0.0017, LR: max. +5.33%, p = 0.0002) and comparison between two ablation steps (max. +54.07%, p = 0.0205). HRA significantly enhanced these relationships, especially in duration (P-wave/LAW: +43.82% to +69.91%, p < 0.0001 for PC and +18.97% to +47.25%, p < 0.0001 for LR, CA effect: +53.90% to +85.72%, p < 0.0210). CQSE reported negligent correlations (0.6−1.2). Direct analysis of CS features is unreliable to evaluate atrial substrate modification due to CA. HRA substantially solves this problem, potentiating correlation with P-wave features. Hence, its application is highly recommended.
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Affiliation(s)
- Aikaterini Vraka
- BioMIT.org, Electronic Engineering Department, Universitat Politecnica de Valencia, 46022 Valencia, Spain;
| | - José Moreno-Arribas
- Cardiology Department, Saint John’s University Hospital, 03550 Alicante, Spain;
| | - Juan M. Gracia-Baena
- Cardiovascular Surgery Department, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (J.M.G.-B.); (F.H.)
| | - Fernando Hornero
- Cardiovascular Surgery Department, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (J.M.G.-B.); (F.H.)
| | - Raúl Alcaraz
- Research Group in Electronic, Biomedical and Telecommunication Engineering, University of Castilla-La Mancha, 16071 Cuenca, Spain;
| | - José J. Rieta
- BioMIT.org, Electronic Engineering Department, Universitat Politecnica de Valencia, 46022 Valencia, Spain;
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Vraka A, Bertomeu-González V, Fácila L, Moreno-Arribas J, Alcaraz R, Rieta JJ. The Dissimilar Impact in Atrial Substrate Modificationof Left and Right Pulmonary Veins Isolation after Catheter Ablation of Paroxysmal Atrial Fibrillation. J Pers Med 2022; 12:462. [PMID: 35330463 PMCID: PMC8955667 DOI: 10.3390/jpm12030462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 12/13/2022] Open
Abstract
Since the discovery of pulmonary veins (PVs) as foci of atrial fibrillation (AF), the commonest cardiac arrhythmia, investigation revolves around PVs catheter ablation (CA) results. Notwithstanding, CA process itself is rather neglected. We aim to decompose crucial CA steps: coronary sinus (CS) catheterization and the impact of left and right PVs isolation (LPVI, RPVI), separately. We recruited 40 paroxysmal AF patients undergoing first-time CA and obtained five-minute lead II and bipolar CS recordings during sinus rhythm (SR) before CA (B), after LPVI (L) and after RPVI (R). Among others, duration, amplitude and atrial-rate variability (ARV) were calculated for P-waves and CS local activation waves (LAWs). LAWs features were compared among CS channels for reliability analysis. P-waves and LAWs features were compared after each ablation step (B, L, R). CS channels: amplitude and area were different between distal/medial (p≤0.0014) and distal/mid-proximal channels (p≤0.0025). Medial and distal showed the most and least coherent values, respectively. Correlation was higher in proximal (≥93%) than distal (≤91%) areas. P-waves: duration was significantly shortened after LPVI (after L: p=0.0012, −13.30%). LAWs: insignificant variations. ARV modification was more prominent in LAWs (L: >+73.12%, p≤0.0480, R: <−33.94%, p≤0.0642). Medial/mid-proximal channels are recommended during SR. CS LAWs are not significantly affected by CA but they describe more precisely CA-induced ARV modifications. LPVI provokes the highest impact in paroxysmal AF CA, significantly modifying P-wave duration.
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Affiliation(s)
- Aikaterini Vraka
- BioMIT.org, Electronic Engineering Department, Universitat Politecnica de Valencia, 46022 Valencia, Spain;
| | - Vicente Bertomeu-González
- Cardiology Department, Saint John’s University Hospital, 03550 Alicante, Spain; (V.B.-G.); (J.M.-A.)
| | - Lorenzo Fácila
- Cardiology Department, General University Hospital Consortium of Valencia, 46014 Valencia, Spain;
| | - José Moreno-Arribas
- Cardiology Department, Saint John’s University Hospital, 03550 Alicante, Spain; (V.B.-G.); (J.M.-A.)
| | - Raúl Alcaraz
- Research Group in Electronic, Biomedical and Telecommunication Engineering, University of Castilla-La Mancha, 16071 Cuenca, Spain;
| | - José J. Rieta
- BioMIT.org, Electronic Engineering Department, Universitat Politecnica de Valencia, 46022 Valencia, Spain;
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Bozorgi A, Khoshnevis M, Hosseinsabet A. Agreement Between Electrophysiology Study and Tissue Doppler Imaging Regarding the Measurement of Total Atrial Conduction Time and Left Atrial Conduction Delay. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:544-556. [PMID: 31810803 DOI: 10.1016/j.ultrasmedbio.2019.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/25/2019] [Accepted: 10/27/2019] [Indexed: 06/10/2023]
Abstract
The aim of our study was to evaluate the agreement between tissue Doppler imaging (TDI) methods and electrophysiology study (EPS) concerning the measurement of total atrial conduction time (TACT) and left atrial conduction delay (LACD). Sixty-nine candidates for EPS were included. TACT and LACD were measured in the EPS. The TDI time intervals for each patient were measured using both pulsed-wave (PW) and 2-D color-coded (CC) methods, once from the beginning of the P wave to the beginning of the a' wave (Tb) and once again to the peak of the a' wave (Tp) at the mitral annulus. TACT and LACD measured by TDI were not in good agreement with those measured by EPS. There was moderate agreement between PW-Tb and CC-Tb and good agreement between PW-Tp and CC-Tp for the measurement of TACT; nevertheless, agreement was not good in the case of LACD.
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Affiliation(s)
- Ali Bozorgi
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Khoshnevis
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Hosseinsabet
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
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Furniss GO, Panagopoulos D, Kanoun S, Davies EJ, Tomlinson DR, Haywood GA. The Effect of Atrial Fibrillation Ablation Techniques on P Wave Duration and P Wave Dispersion. Heart Lung Circ 2018; 28:389-396. [PMID: 29501465 DOI: 10.1016/j.hlc.2018.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/10/2018] [Accepted: 02/04/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND A reduction in surface electrocardiogram (ECG) P wave duration and dispersion is associated with improved outcomes in atrial fibrillation ablation. We investigated the effects of different ablation strategies on P wave duration and dispersion, hypothesising that extensive left atrial (LA) ablation with left atrial posterior wall isolation would give a greater reduction in P wave duration than more limited ablation techniques. METHODS A retrospective analysis of ECGs from patients who have undergone atrial fibrillation (AF) ablation was performed and pre-procedural sinus rhythm ECGs were compared with the post procedure ECGs. Maximal P wave duration was measured in leads I or II, minimum P wave duration in any lead and values were calculated for P wave duration and dispersion. Left atrial dimensions and medications at the time of ECG were documented. Ablation strategies compared were; pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) and the persistent AF (PsAF) ablation strategies of pulmonary vein isolation plus additional linear lesions (Lines), left atrial posterior wall isolation via catheter (PWI) and left atrial posterior wall isolation via staged surgical and catheter ablation (Hybrid). RESULTS Sixty-nine patients' ECGs were analysed: 19 PVI, 21 Lines, 14 PWI, 15 Hybrid. Little correlation was seen between pre-procedure left atrial size and P wave duration (r=0.24) but LA size and P wave duration was larger in PsAF patients. A significant difference was seen in P wave reduction driven by Hybrid AF ablation (p<0.005) and Lines (<0.02). There was no difference amongst P wave dispersion between groups but the largest reduction was seen in the Hybrid ablation group. CONCLUSIONS P wave duration increased with duration of continuous atrial fibrillation. Hybrid AF ablation significantly reduced P wave duration and dispersion compared to other ablation strategies including posterior wall isolation via catheter despite this being the same lesion set.
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Affiliation(s)
- Guy O Furniss
- Musgrove Park Hospital, Taunton, UK; University of Plymouth, Plymouth, UK; Southwest Cardiothoracic Centre, Derriford Hospital, Plymouth, UK.
| | | | - Sadeek Kanoun
- Southwest Cardiothoracic Centre, Derriford Hospital, Plymouth, UK
| | - Edward J Davies
- Southwest Cardiothoracic Centre, Derriford Hospital, Plymouth, UK
| | | | - Guy A Haywood
- Southwest Cardiothoracic Centre, Derriford Hospital, Plymouth, UK
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