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Reduction of P-Wave Duration and Successful Pulmonary Vein Isolation in Patients with Atrial Fibrillation

Authors

  • MASAHIRO OGAWA M.D.,

    1. Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan; the
    2. Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center
    3. David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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  • KOICHIRO KUMAGAI M.D.,

    1. Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan; the
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  • MARTA VAKULENKO M.D.,

    1. David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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  • TOMOO YASUDA M.D.,

    1. Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan; the
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  • CARIN SIEGERMAN Ph.D.,

    1. David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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  • ALAN GARFINKEL Ph.D.,

    1. David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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  • PENG-SHENG CHEN M.D.,

    1. Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center
    2. David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
    3. Krannert Institute of Cardiology and the Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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  • KEIJIRO SAKU M.D.

    1. Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan; the
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  • This study was supported by the NIH Grants P01 HL78931, R01 HL78932, and 71140.

  • Manuscript received 27 February 2007; Revised manuscript received 11 April 2007; Accepted for publication 7 May 2007.

Address for correspondence: Masahiro Ogawa, M.D., Department of Cardiology, Fukuoka University School of Medicine 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan. Fax: +81-92-865-2692; E-mail: ogawamas@kc4.so-net.ne.jp

Abstract

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.

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