P-wave alternans rebound following pulmonary vein isolation predicts atrial arrhythmia recurrence

The Role of P-Wave Variables in Enhancing Prediction of New-Onset Atrial Fibrillation in Patients With Acute Myocardial Infarction

BACKGROUND

After acute myocardial infarction (AMI), it is common to observe new-onset atrial fibrillation (NOAF), which is often related to a negative prognosis. Some P-wave variables (P-wave duration [PWD], P-wave amplitude, and interatrial block [IAB]), reflecting the process of electrical and structural remodeling, could predict the risk of atrial fibrillation (AF). This study aimed to assess the predictive value of P-wave variables for post-AMI NOAF.

METHODS

We retrospectively analyzed 1581 AMI patients with no prior AF, using follow-up data from January 2023 to January 2024. P-wave variables were measured, and patients were grouped based on in-hospital NOAF occurrence.

RESULTS

Overall, 164 (10.3%) of the 1581 patients had NOAF. The age (61.08 ± 12.02 vs. 67.91 ± 11.60, p < 0.001), left atrial size (36.31 ± 3.94 vs. 39.12 ± 5.51, p < 0.001), Brain Natriuretic Peptide (1588.45 ± 3346.18 vs. 3864.39 ± 6251.92, p < 0.001), P-wave variables (PWD: 102.78 ± 12.56 vs. 117.88 ± 18.81, p < 0.001; P-wave amplitude: 0.12 ± 0.04 vs. 0.13 ± 0.04, p = 0.041; interatrial block: 89.6% vs. 10.3%, p < 0.001), congestive heart failure (4.7% vs. 23.2%, p < 0.001), and Killip > 1 (25.3% vs. 55.5%, p < 0.001) showed significant differences between the non-AF and NOAF groups. P-wave variables were significantly associated with an increased risk of NOAF in multivariable regression analysis.

CONCLUSIONS

The addition of P-wave variables to AF risk factors from literature and guidelines significantly improved NOAF risk discrimination. P-wave variables were strongly associated with NOAF after AMI. Adding these variables enhanced the predictive performance for post-AMI NOAF.