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Association between P-wave terminal force in lead V1 and extent of left atrial low-voltage substrate in older patients with paroxysmal atrial fibrillation

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Abstract

Background

The P-wave terminal force in lead V1 (PTFV1) is a marker of cardiomyopathy and risk of atrial fibrillation (AF). Low-voltage area (LVA) in the left atrium (LA), which indicates underlying atrial fibrosis, could predict AF recurrence. This study aimed to investigate the correlation between PTFV1 and LVA in older patients with paroxysmal AF.

Methods

From May 1, 2020, to October 31, 2021, a total of 162 patients aged 65–80 years with paroxysmal AF who underwent index ablation procedures were enrolled. PTFV1 was measured in sinus rhythm (SR) using 12-lead electrocardiograms prior to the ablation. Abnormal PTFV1 was defined as a ≥ 4 mVms depression. Additional LVA ablation beyond circumferential pulmonary vein isolation (CPVI) was performed if LVAs were found.

Results

Among the 162 patients, 88 had a normal PTFV1 and 74 had an abnormal PTFV1 prior to ablation. There was a significant difference in LVA in patients with and without an abnormal PTFV1 (LVA, 11.0 vs. 5.1 cm2, P < 0.001; LVA burden, 8.9% vs. 4.5%, P < 0.001). PTFV1 and PTAV1 were highest in the upper tertile with extensive LVAs (P < 0.001). Multivariate analysis revealed that abnormal PTFV1 was an independent predictor of LVAs (β = 4.961; 95% CI, 2.135–7.788; P < 0.001). After a median follow-up of 23 months, the AF-free survival rate was similar between the normal PTFV1 group and the abnormal PTFV1 group (13/88 vs. 12/74, hazard ratio [HR], 0.933 [95% CI, 0.425–2.047]; P = 0.861).

Conclusions

Abnormal PTFV1 at baseline was independently associated with the extent of LVA in older patients with paroxysmal AF.

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Data Availability

Data available on request from the authors.

Abbreviations

PTFV1 :

P-wave terminal force in lead V1

AF:

Atrial fibrillation

SR:

Sinus rhythm

LVA:

Low-voltage area

LA:

Left atrial

PVI:

Pulmonary vein isolation

PWD:

P-wave duration

PWA:

P-wave amplitude

PTDV1 :

P-wave terminal duration in lead V1

PTAV1 :

P-wave terminal amplitude in lead V1

PWR:

P-wave duration-amplitude ratio

LAD:

Left atrial diameter

LVEF:

Left ventricular ejection fraction

AADs:

Antiarrhythmic drugs

DTNPV1 :

Deep terminal negativity of P wave in V1

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Funding

This work was supported by the National Natural Science Foundation of China (grant number 82170322).

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Author notes

  1. Yue Qiu and Jingyu Sun contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China

    Yue Qiu, Jinyu Sun, Yuxuan Wang, Caiyi Jin, Weizhu Ju, Gang Yang, Kai Gu, Hailei Liu, Zidun Wang, Xiaohong Jiang, Mingfang Li, Hongwu Chen & Minglong Chen

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  1. Yue Qiu
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Correspondence to Hongwu Chen or Minglong Chen.

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This study was approved by the Ethics Committee of The First Affiliated Hospital of Nanjing Medical University. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Qiu, Y., Sun, J., Wang, Y. et al. Association between P-wave terminal force in lead V1 and extent of left atrial low-voltage substrate in older patients with paroxysmal atrial fibrillation. J Interv Card Electrophysiol (2023). https://doi.org/10.1007/s10840-023-01710-w

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