BACKGROUND: Circumferential pulmonary vein isolation (CPVI) is a widely used treatment for paroxysmal atrial fibrillation (AF). Several P wave duration (PWD) parameters have been suggested to predict post-ablation recurrence, but their use remains controversial. This study aimed to identify novel P wave indices that predict post-ablation AF recurrence.

MATERIAL AND METHODS: We selected 171 consecutive patients undergoing CPVI for paroxysmal AF. Electrocardiography (ECG) recordings were obtained at the beginning and the end of ablation. PWD was measured in all 12 leads. The PWD variation was calculated by subtracting the pre-ablation PWD from the post-ablation PWD.

RESULTS: PWD was significantly shortened in leads II, III, aVF, and V1 after ablation. During a mean follow-up of 19.96±4.32 months, AF recurrence occurred in 32 (18.7%) patients. No significant differences in baseline characteristics or pre- or post-ablation PWD were observed between the AF recurrence and non-recurrence groups. Patients with AF recurrence exhibited a smaller PWD variation in leads II (1.21(–0.56, 2.40) vs. –5.77(–9.10, –4.06) ms, P<0.001), III (–5.92(–9.87, 3.27) vs. –9.44(–11.89, –5.57) ms, P=0.001) and V1 (–4.43(–6.64, –3.13) vs. –6.33(–8.19,–4.59) ms, P=0.003). Multivariable logistic regression analysis demonstrated that smaller PWD variations in lead II and III were independent risk factors for AF recurrence. PWD variation ≥–2.21 ms in lead II displayed the highest combined sensitivity and specificity (85.29% and 83.94%, respectively) for predicting post-ablation AF recurrence. A PWD variation ≥0 ms displayed the best practical value in predicting AF recurrence.

CONCLUSIONS: PWD variation in lead II is an effective predictor of post-ablation AF recurrence.

Keywords: Atrial Fibrillation - surgery, Catheter Ablation - methods, Electrocardiography - methods, Pulmonary Veins - physiopathology, Recurrence, Sensitivity and Specificity