Splitting the P-Wave: Improved Evaluation of Left Atrial Substrate Modification after Pulmonary Vein Isolation of Paroxysmal Atrial Fibrillation.
Aikaterini VrakaVivencio BarriosFernando HorneroAurelio QuesadaRaúl AlcarazJosé Joaquín RietaPublished in: Sensors (Basel, Switzerland) (2021)
Atrial substrate modification after pulmonary vein isolation (PVI) of paroxysmal atrial fibrillation (pAF) can be assessed non-invasively by analyzing P-wave duration in the electrocardiogram (ECG). However, whether right (RA) and left atrium (LA) contribute equally to this phenomenon remains unknown. The present study splits fundamental P-wave features to investigate the different RA and LA contributions to P-wave duration. Recordings of 29 pAF patients undergoing first-ever PVI were acquired before and after PVI. P-wave features were calculated: P-wave duration (PWD), duration of the first (PWDon-peak) and second (PWDpeak-off) P-wave halves, estimating RA and LA conduction, respectively. P-wave onset (PWon-R) or offset (PWoff-R) to R-peak interval, measuring combined atrial/atrioventricular and single atrioventricular conduction, respectively. Heart-rate fluctuation was corrected by scaling. Pre- and post-PVI results were compared with Mann-Whitney U-test. PWD was correlated with the remaining features. Only PWD (non-scaling: Δ=-9.84%, p=0.0085, scaling: Δ=-17.96%, p=0.0442) and PWDpeak-off (non-scaling: Δ=-22.03%, p=0.0250, scaling: Δ=-27.77%, p=0.0268) were decreased. Correlation of all features with PWD was significant before/after PVI (p<0.0001), showing the highest value between PWD and PWon-R (ρmax=0.855). PWD correlated more with PWDon-peak (ρ= 0.540-0.805) than PWDpeak-off (ρ= 0.419-0.710). PWD shortening after PVI of pAF stems mainly from the second half of the P-wave. Therefore, noninvasive estimation of LA conduction time is critical for the study of atrial substrate modification after PVI and should be addressed by splitting the P-wave in order to achieve improved estimations.
Keyphrases
- atrial fibrillation
- catheter ablation
- left atrial
- heart rate
- left atrial appendage
- heart failure
- oral anticoagulants
- rheumatoid arthritis
- patients undergoing
- left ventricular
- heart rate variability
- mitral valve
- direct oral anticoagulants
- systemic sclerosis
- idiopathic pulmonary fibrosis
- pulmonary hypertension
- pulmonary artery
- venous thromboembolism
- vena cava