This study was supported by the NIH Grants P01 HL78931, R01 HL78932, and 71140.
Reduction of P-Wave Duration and Successful Pulmonary Vein Isolation in Patients with Atrial Fibrillation
Article first published online: 27 JUL 2007
Journal of Cardiovascular Electrophysiology
Volume 18, Issue 9, pages 931–938, September 2007
How to Cite
OGAWA, M., KUMAGAI, K., VAKULENKO, M., YASUDA, T., SIEGERMAN, C., GARFINKEL, A., CHEN, P.-S. and SAKU, K. (2007), Reduction of P-Wave Duration and Successful Pulmonary Vein Isolation in Patients with Atrial Fibrillation. Journal of Cardiovascular Electrophysiology, 18: 931–938. doi: 10.1111/j.1540-8167.2007.00890.x
Manuscript received 27 February 2007; Revised manuscript received 11 April 2007; Accepted for publication 7 May 2007.
- Issue published online: 27 JUL 2007
- Article first published online: 27 JUL 2007
- atrial fibrillation;
- pulmonary vein isolation;
- P wave;
- P-wave signal averaged electrocardiogram
Introduction: We hypothesize that successful pulmonary vein (PV) isolation can shorten the P-wave duration in patients with atrial fibrillation (AF).
Methods and Results: We recorded magnified surface electrocardiogram (ECG) and P-wave signal-averaged ECG using 12 electrode leads before and after 31 PV isolation procedures in 27 patients with AF. The patients were followed for 16 ± 4 months. Repeat ablation studies documented failed PV isolation in seven patients with AF recurrences. At baseline, the maximal P-wave duration in patients without AF recurrence (161 ± 7 msec) was slightly shorter than that in patients with AF recurrence (168 ± 10 msec, P < 0.05). After ablation, patients without recurrence showed a significant reduction of P-wave duration from 161 ± 7 msec to 151 ± 8 msec (P < 0.0001). In contrast, no change of P-wave duration was noted in patients with recurrences. These findings were confirmed with signal averaged ECG of the P-waves. Three-dimensional (3-D) computer simulation using an atrial cell model showed that elimination of the muscle sleeves inside the PV resulted in a shortening of the P-wave duration and change of the terminal portion of the P-wave morphology.
Conclusions: A significant shortening of P-wave duration by P-wave signal-averaged ECG can be used as an indicator for successful PV isolation. These findings suggest that activation of the PV muscle sleeves may be an important component of the terminal portion of the P-wave on surface ECG.