Abstract
Background
The P wave peak time (PWPT) is a predictor of paroxysmal atrial fibrillation (PAF). High-power short-duration ablation has been associated with improved durability of circumferential pulmonary vein electrical isolation (PVI). We investigated the effect of high-power short-duration PVI on PWPT in patients with PAF.
Methods
Out of 111 patients with PAF, 91 received radiofrequency ablation (ablation group) and 20 received medication treatment (control group). A VIZIGO sheath and an STSF catheter (Biosense Webster, CA, USA) were used together for high-power short-duration circumferential PVI at ablation index values of 500 and 400 for the anterior and posterior walls, respectively. The patients were followed up for 12 months.
Results
The preoperative PWPT in the ablation group was similar to that in the control group: PWPT II = 54.38 ± 6.18 ms vs. 54.35 ± 6.12 ms (p > 0.05), PWPT V1 = 54.19 ± 6.21 ms vs. 54.31 ± 6.08 ms (p > 0.05), respectively. Circumferential PVI was achieved for all patients in the ablation group during the operation. At the 12-month follow-up, there were seven cases of AF recurrence. The PWPT in the ablation group 12 months postoperatively was shorter than the preoperative value: PWPT II = 49.39 ± 7.11 ms vs. 54.38 ± 6.18 ms (p < 0.001), PWPT V1 = 47.69 ± 7.01 ms vs. 54.19 ± 6.21 ms (p < 0.001). The PWPT in the patients with AF recurrence was significantly longer than that in the non-recurrence patients: PWPT II = 50.48 ± 7.12 ms vs. 47.33 ± 6.21 ms (p < 0.001), PWPT V1 = 50.84 ± 7.05 ms vs. 47.19 ± 6.27 ms, (p < 0.001). The PWPT of the control group at the 12-month follow-up was similar to the baseline level: PWPT II = 54.32 ± 6.20 ms vs. 54.35 ± 6.12 ms (p > 0.05), PWPT V1 = 53.89 ± 6.01 ms vs. 54.31 ± 6.08 ms (p > 0.05).
Conclusion
The results showed that high-power short-duration PVI had a positive effect on PWPT, which is a predictor of PAF.
Zusammenfassung
Hintergrund
Die Zeitdauer vom Beginn bis zum Gipfel der P‑Welle („P wave peak time“, PWPT) ist ein Prädiktor des paroxysmalen Vorhofflimmerns (PVF). Die Hochenergie-Kurzzeit-Ablation wurde mit einer besseren Dauerhaftigkeit der zirkumferenziellen elektrischen Pulmonalvenenisolation (PVI) in Verbindung gebracht. In der vorliegenden Arbeit wurde die Auswirkung der Hochenergie-Kurzzeit-PVI auf die PWPT bei Patienten mit PVF untersucht.
Methoden
Von 111 Patienten mit PAF erhielten 91 eine Behandlung mittels Radiofrequenzablation (Ablationsgruppe) und 20 eine medikamentöse Therapie (Kontrollgruppe). Ein VIZIGO-Schleuse (Fa. Biosense Webster, Irvine, CA, USA) und ein Smart-Touch-Surround-Flow(STSF)-Katheter (Fa. Biosense Webster) wurden zusammen für die zirkumferenzielle Hochenergie-Kurzzeit-PVI mit Ablationsindexwerten von 500 bzw. 400 für die Vorder- und Hinterwand verwendet. Die Patienten wurden 12 Monate lang nachbeobachtet.
Ergebnisse
Die präoperative PWPT in der Ablationsgruppe war ähnlich wie die in der Kontrollgruppe: PWPT II = 54,38 ± 6,18 ms vs. 54,35 ± 6,12 ms (p > 0,05) bzw. PWPT V1 = 54,19 ± 6,21 ms vs. 54,31 ± 6,08 ms (p > 0,05). Bei sämtlichen Patienten in der Ablationsgruppe wurde eine zirkumferenzielle PVI während der Operation erzielt. Beim 12-Monats-Follow-up gab es 7 Fälle mit Wiederauftreten des VF. Die PWPT in der Ablationsgruppe war 12 Monate postoperativ kürzer als der präoperative Wert: PWPT II = 49,39 ± 7,11 ms vs. 54,38 ± 6,18 ms (p < 0,001); PWPT V1 = 47,69 ± 7,01 ms vs. 54,19 ± 6,21 ms (p < 0,001). Die PWPT bei den Patienten mit VF-Rezidiv war signifikant länger als die bei den Patienten ohne VF-Rezidiv: PWPT II = 50,48 ± 7,12 ms vs. 47,33 ± 6,21 ms (p < 0,001); PWPT V1 = 50,84 ± 7,05 ms vs. 47,19 ± 6,27 ms; (p < 0,001). In der Kontrollgruppe war die PWPT beim 12-Monats-Follow-up ähnlich wie der Ausgangswert: PWPT II = 54,32 ± 6,20 ms vs. 54,35 ± 6,12 ms (p > 0,05); PWPT V1 = 53,89 ± 6,01 ms vs. 54,31 ± 6,08 ms (p > 0,05).
Schlussfolgerung
Den Ergebnissen zufolge hat die Hochenergie-Kurzzeit-PVI positive Auswirkungen auf die PWPT, die einen Prädiktor für PVF darstellt.
Similar content being viewed by others
References
Hindricks G, Potpara T, Dagres N et al (2021) 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 42(5):373–498
Kornej J, Börschel CS, Benjamin EJ et al (2020) Epidemiology of Atrial Fibrillation in the 21st. Century: Nov Methods New Insightscirc Res 127(1):4–20
Bayés de Luna A, Baranchuk A, Martínez-Sellés M (2017) Anticoagulation in patients at high risk of stroke without documented atrial fibrillation. Time for a paradigm shift? Ann Noninvasive Electrocardiol 22(1):e12417
Chen LY, Soliman EZ (2019) P wave indices-advancing our understanding of atrial fibrillation-related cardiovascular outcomes. Front Cardiovasc Med 6:53
Çağdaş M, Karakoyun S, Rencüzoğulları İ et al (2020) P wave peak time; a novel electrocardiographic parameter in the assessment of coronary no-reflow. J Electrocardiol 50(5):584–590
Bayam E, Yıldırım E, Kalçık M et al (2021) Relationship between P wave peak time and coronary artery disease severity in non-ST elevation acute coronary syndrome. Herz 46(2):188–194
Chen LY, Ribeiro ALP, Platonov PG et al (2022) P Wave Parameters and Indices: A Critical Appraisal of Clinical Utility, Challenges, and Future Research‑A Consensus Document Endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology. Circ Arrhythm Electrophysiol 15(4):e10435
Öz A, Cinar T, Kızılto GC et al (2020) Novel electrocardiography parameter for paroxysmal atrial fibrillation in acute ischaemic stroke patients: P wave peak time. Postgrad Med J 96(1140):584–588
Yamaguchi T, Tsuchiya T, Fukui A et al (2018) Impact of the extent of low-voltage zone on outcomes after voltage-based catheter ablation for persistent atrial fibrillation. J Cardiol 72(5):427–433
Masuda M, Fujita M, Iida O et al (2018) Left atrial low-voltage areas predict atrial fibrillation recurrence after catheter ablation in patients with paroxysmal atrial fibrillation. Int J Cardiol 257:97–101
Vlachos K, Efremidis M, Letsas KP et al (2017) Low-voltage areas detected by high-density electroanatomical mapping predict recurrence after ablation for paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 28:1393–1402
Hohendanner F, Romero I, Blaschke F et al (2018) Extent and magnitude of low-voltage areas assessed by ultra-high-density electroanatomical mapping correlate with left atrial function. Int J Cardiol 272:108–112
Ibisoglu E, Boyraz B, Güneş ST et al (2021) Impact of surgical weight loss on novel P‑wave-related variables which are nominated as predictors of atrial arrhythmias. Pacing Clin Electrophysiol 44(9):1516–1522
Yıldız İ, Yildiz ÖP, Burak C et al (2020) P Wave Peak Time for Predicting an Increased Left Atrial Volume Index in Hemodialysis Patients. Med Princ Pract 29(3):262–269
Aslan B, Akyüz A, Işık F et al (2022) The effect of empagliflozin on P wave peak time and other P wave parameters in patients with diabetes mellitus. Pacing Clin Electrophysiol 45(3):323–329
Yıldırım E, Günay N, Bayam E et al (2019) Relationship between paroxysmal atrial fibrillation and a novel electrocardiographic parameter P wave peak time. J Electrocardiol 57:81–86
Zengin A, Karataş MB, Çanga Y et al (2022) A novel electrocardiographic parameter for the prediction of atrial fibrillation after coronary artery bypass graft surgery “P wave peak time”. Ir J Med Sci 191(6):2579–2585
Castrejón-Castrejón S, Martínez Cossiani M, Ortega Molina M et al (2020) Feasibility and safety of pulmonary vein isolation by high-power short-duration radiofrequency application: shortterm results of the POWER-FAST PILOT study. J Interv Card Electrophysiol 57(1):57–65
Reddy VY, Grimaldi M, De Potter T et al (2019) Pulmonary Vein Isolation With Very High Power, Short Duration, Temperature-Controlled Lesions: The QDOT-FAST Trial. JACC Clin Electrophysiol 5(7:778–786
Castrejón-Castrejón S, Martínez Cossiani M, Jáuregui-Abularach M et al (2023) Multicenter prospective comparison of conventional and high-power short duration radiofrequency application for pulmonary vein isolation: the high-power short-duration radiofrequency application for faster and safer pulmonary vein ablation (POWER FAST III) trial. J Interv Card Electrophysiol. https://doi.org/10.1007/s10840-023-01509-9
Yamasaki H, Aonuma K, Shinoda Y et al (2019) Initial Result of Antrum Pulmonary Vein Isolation Using the Radiofrequency Hot-Balloon CatheterWith Single-Shot Technique. JACC Clin Electrophysiol 5(3):354–363
Maille B, Das M, Hussein A et al (2020) Reverse electrical and structural remodeling of the left atrium occurs early after pulmonary vein isolation for persistent atrial fibrillation. J Interv Card Electrophysiol 58(1):9–19
Soulat-Dufour L, Lang S, Addetia K et al (2022) Restoring Sinus Rhythm Reverses Cardiac Remodeling and Reduces Valvular Regurgitation in Patients With Atrial Fibrillation. J Am Coll Cardiol 79(10):951–961
Masuda M, Asai M, Iida O et al (2022) Low-Voltage-Area Ablation in Paroxysmal Atrial Fibrillation-Extended Follow-up Results of the VOLCANO Trial. Circ J 86(2):245–252
Funding
This work was supported in part by the Cultivation Plan of Clinical Research, Second Affiliated Hospital of Anhui Medical University (2021LCYB19), and the Scientific Research Foundation of Education Department of Anhui Province of China (2022AH050658).
Author information
Authors and Affiliations
Contributions
Meng Wang and Xiaochen Wang contributed to the conception and design. Meng Wang and Pei Bao contributed to the acquisition, analysis, and interpretation of the data, and the drafting of the article. Meng Wang, Zheng Huang, and Xiaochen Wang revised the article for intellectual content. Meng Wang, Xiaochen Wang, and Feng Gao finally approved the completed article.
Corresponding author
Ethics declarations
Conflict of interest
M. Wang, X. Wang, F. Gao, P. Bao and Z. Huang declare that they have no competing interests.
For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.
Rights and permissions
About this article
Cite this article
Wang, M., Wang, X., Gao, F. et al. The effect of high-power short-duration pulmonary vein isolation on PWPT—a predictor of paroxysmal atrial fibrillation. Herz 49, 69–74 (2024). https://doi.org/10.1007/s00059-023-05198-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00059-023-05198-y
Keywords
- Paroxysmal atrial fibrillation
- High-power short-duration ablation
- PWPT
- Pulmonary vein isolation
- Predictor