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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This work was supported by the National Natural Science Foundation of China (grant number 82170322).
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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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DOI: https://doi.org/10.1007/s10840-023-01710-w