Long P-wave duration immediately after pulmonary vein isolation on radiofrequency catheter ablation for atrial fibrillation predicts clinical recurrence: correlation with atrial remodeling in persistent atrial fibrillation

Ohguchi, Shiou; Inden, Yasuya; Shigematsu, Takuro; Yasuda, Keiichi; Katagiri, Ken; Oguri, Mitsutoshi; Murohara, Toyoaki

doi:10.1007/s00380-021-01932-w

Cited by 8 publications

(5 citation statements)

References 30 publications

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“…In a recent study by Moreno-Weidmann et al ( 11 ), APW duration was an independent predictor of recurrence post radiofrequency ablation for paroxysmal and persistent AF. Similar findings were observed in small single-centre experiences by Liu et al ( 17 ) and Ohguchi et al ( 18 ). Of note, none of the previous studies have explored the predictive value of APW following cryoballoon ablation.…”

Section: Discussionsupporting

confidence: 90%

Amplified sinus-P-wave analysis predicts outcomes of cryoballoon ablation in patients with persistent and long-standing persistent atrial fibrillation: A multicentre study

Creta

Venier

Tampakis

et al. 2023

Front. Cardiovasc. Med.

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IntroductionOutcomes of catheter ablation for non-paroxysmal atrial fibrillation (AF) remain suboptimal. Non-invasive stratification of patients based on the presence of atrial cardiomyopathy (ACM) could allow to identify the best responders to pulmonary vein isolation (PVI).MethodsObservational multicentre retrospective study in patients undergoing cryoballoon-PVI for non-paroxysmal AF. The duration of amplified P-wave (APW) was measured from a digitally recorded 12-lead electrocardiogram during the procedure. If patients were in AF, direct-current cardioversion was performed to allow APW measurement in sinus rhythm. An APW cut-off of 150 ms was used to identify patients with significant ACM. We assessed freedom from arrhythmia recurrence at long-term follow-up in patients with APW ≥ 150 ms vs. APW < 150 ms.ResultsWe included 295 patients (mean age 62.3 ± 10.6), of whom 193 (65.4%) suffered from persistent AF and the remaining 102 (34.6%) from long-standing persistent AF. One-hundred-forty-two patients (50.2%) experienced arrhythmia recurrence during a mean follow-up of 793 ± 604 days. Patients with APW ≥ 150 ms had a significantly higher recurrence rate post ablation compared to those with APW < 150 ms (57.0% vs. 41.6%; log-rank p < 0.001). On a multivariable Cox-regression analysis, APW≥150 ms was the only independent predictor of arrhythmia recurrence post ablation (HR 2.03 CI95% 1.28–3.21; p = 0.002).ConclusionAPW duration predicts arrhythmia recurrence post cryoballoon-PVI in persistent and long-standing persistent AF. An APW cut-off of 150 ms allows to identify patients with significant ACM who have worse outcomes post PVI. Analysis of APW represents an easy, non-invasive and highly reproducible diagnostic tool which allows to identify patients who are the most likely to benefit from PVI-only approach.

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Section: Discussionsupporting

confidence: 90%

Amplified sinus-P-wave analysis predicts outcomes of cryoballoon ablation in patients with persistent and long-standing persistent atrial fibrillation: A multicentre study

Creta

Venier

Tampakis

et al. 2023

Front. Cardiovasc. Med.

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“…Sato et al recently reported that slower global LA-CV on an imaging system was associated with AF recurrence after PVI [19]. Although other CV measurement methods include the value calculated between geodesic linear pole pairs or in triad areas with minimum interelectrode distance along the wave front path [13,[20][21][22], they are considered to indicate local or regional CV, which only show limited electrical characteristics in LA. Our unique model of the magnitude of the matched orthogonal projection vector calculated in the triangle area can indicate regional CV and can also represent a gravel CV by evaluating the median of LA-CVs among four different sample sites in both the anterior and posterior walls separately.…”

Section: Discussionmentioning

confidence: 99%

“…All ablation procedures including PVI were performed under the guidance of the 3D-electroanatomical mapping system (CARTO, Biosense Webster) with an LA geometry obtained from the CT image [ 13 ]. Intravenous heparin (100 IU/kg) was administered immediately after the puncture and was added properly to maintain an activated clotting time of 300–350 s during the procedure [ 14 , 15 ].…”

Section: Methodsmentioning

confidence: 99%

“…Intravenous heparin (100 IU/kg) was administered immediately after the puncture and was added properly to maintain an activated clotting time of 300–350 s during the procedure [ 14 , 15 ]. We used a 3.5 mm tip, open-irrigated contact force sensing ablation catheter (25–35 W, 42 °C, irrigation flow rate of 17–30 mL/min; Navistar ThermoCool SmartTouch, Biosense Webster, Inc.), a circular mapping catheter for PVI (Lasso, Biosense Webster, Inc., USA), and a multi-electrode mapping catheter for 3D-electroanatomical mapping (PentaRay, Biosense Webster, Inc., USA) [ 13 ]. The contact force of the catheter was targeted at 10–25 g, and catheter stability was set with a force-time integral of > 100 g*s. PVI was confirmed by the elimination of PV potentials recorded by a circular mapping catheter and bi-directional electrical block between the LA and PV [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

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Regional left atrial conduction velocity in the anterior wall is associated with clinical recurrence of atrial fibrillation after catheter ablation: efficacy in combination with the ipsilateral low voltage area

Ohguchi

Inden²,

Fujita³

et al. 2022

BMC Cardiovasc Disord

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Background Left atrial (LA) conduction velocity (CV) is an electrical remodeling parameter of atrial fibrillation (AF) substrate. However, the pathophysiological substrate of LA-CV and its impact on outcomes after catheter ablation for AF have not been well evaluated. Methods We retrospectively evaluated 119 patients with AF who underwent catheter ablation and electroanatomical mapping during sinus rhythm. To measure regional LA-CV, we took triplet sites (A, B, and C) on the activation map and calculated the magnitude of the matched orthogonal projection vector between vector-AB and vector-AC, indicating two-dimensional CV. The median of the LA-CVs from four triad sites in both the anterior and posterior walls was set as the ‘model LA-CV’. We evaluated the impact of the model LA-CV on recurrence after ablation and relationship between the model LA-CV and LA-low voltage area (LVA) of < 0.5 mV. Results During the 12-month follow-up, 29 patients experienced recurrence. The LA-CV model was significantly correlated with ipsilateral LVA. The lower anterior model LA-CV was significantly associated with recurrence, with the cut-off value of 0.80 m/s having a sensitivity of 72% and specificity of 67%. Multivariable analysis revealed that the anterior model LA-CV (hazard ratio, 0.09; 95% confidence interval, 0.01–0.94; p = 0.043) and anterior LA-LVA (hazard ratio, 1.06; 95% confidence interval, 1.00–1.11; p = 0.033) were independently associated with AF recurrence. The anterior LA-LVA was mildly correlated with the anterior model LA-CV (r = -0.358; p < 0.001), and patients with both lower LA-CV and greater anterior LA-LVA based on each cut-off value had the worst prognosis. However, decreased LA-CV was more likely to be affected by the distribution pattern of the LVA rather than the total size of the LVA. Conclusion Decreased anterior LA-CV was a significant predictor of AF recurrence and was a useful electrical parameter in addition to LA-LVA for estimating AF arrhythmogenicity.

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“…Ohguchi et al . [ 36 ] used a defined LACV model that was based on an orthogonal projection vector calculated within the triangle area. There is currently no standard measurement path, which makes it difficult to combine and compare data between different studies.…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Electrophysiological Properties after Pulmonary Vein Isolation Predict the Recurrence of Atrial Fibrillation: A Cohort Study

Gu,

Wang,

Xue

et al. 2024

Rev. Cardiovasc. Med.

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Background: The aim of this work was to investigate left atrial electrophysiological properties for their ability to predict the recurrence of atrial fibrillation (AF) following pulmonary vein isolation (PVI). Methods: The study comprised 53 patients with AF [62 (interquartile range (IQR): 52–68) years old; 47.2% females]. High-density, three-dimensional electro-anatomic mapping using PentaRay was conducted during sinus rhythm in the left atrium (LA) immediately after PVI. LA conduction time, conduction velocity in predefined anterior and posterior routes, low voltage area percentage and distribution were assessed. Results: The AF recurrence group had longer LA conduction time compared to the non-recurrence group [11 (IQR: 10–12) ms vs. 9 (IQR: 8–10) ms, p = 0.001). The percent low voltage area was greater in the recurrence group than the non-recurrence group [31.2 (IRQ: 7.1–49.3)% vs. 7.7 (IQR: 4.3–15.2)%, p = 0.008]. Multivariate Cox regression revealed that LA conduction time independently predicted AF recurrence following ablation over a median follow-up of 235 days [IQR: 154–382 days; hazard ratio (HR): 2.37, 95% confidence interval (CI): 1.08–5.23, p = 0.031]. The optimal cut-off for LA conduction time was 98 ms [area under curve (AUC): 0.926, sensitivity: 0.833, specificity: 0.894, p 0.01]. Kaplan–Meier analysis revealed that patients with a conduction time 98 ms had a higher rate of AF recurrence following ablation ( p 0.001). Conclusions: Patients with longer LA conduction time after PVI had more frequent AF recurrence.

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Long P-wave duration immediately after pulmonary vein isolation on radiofrequency catheter ablation for atrial fibrillation predicts clinical recurrence: correlation with atrial remodeling in persistent atrial fibrillation

Cited by 8 publications

References 30 publications

Amplified sinus-P-wave analysis predicts outcomes of cryoballoon ablation in patients with persistent and long-standing persistent atrial fibrillation: A multicentre study

Amplified sinus-P-wave analysis predicts outcomes of cryoballoon ablation in patients with persistent and long-standing persistent atrial fibrillation: A multicentre study

Regional left atrial conduction velocity in the anterior wall is associated with clinical recurrence of atrial fibrillation after catheter ablation: efficacy in combination with the ipsilateral low voltage area

Left Atrial Electrophysiological Properties after Pulmonary Vein Isolation Predict the Recurrence of Atrial Fibrillation: A Cohort Study

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