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Maximum P-Wave Duration and P-Wave Dispersion Predict Recurrence of Paroxysmal Atrial Fibrillation in Patients with Wolff-Parkinson-White Syndrome after Successful Radiofrequency Catheter Ablation

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Abstract

Background: Identification of patients at risk for PAF recurrence after AP ablation is important because of the necessity for additional therapies.

Objectives: To determine whether Maximum P-wave duration (P max) and P-wave dispersion (P d) detected on surface ECG after successful accessory pathway (AP) ablation can predict the recurrence of paroxysmal atrial fibrillation (PAF).

Methods: Seventy-eight patients with Wolff-Parkinson-White (WPW) syndrome who had at least one documented PAF episode and underwent catheter ablation were enrolled. Pmax, minimum P-wave duration (P min) and P d were determined on a surface ECG recorded on a high resolution computer screen on day 2 after ablation of the AP.

Results: There was no significant difference in terms of basic clinical data and electrophysiological findings between patients with (Group-1, n = 19) and without (Group-2, n = 59) recurrence of PAF during follow-up of 21 ± 10 months. P max and P d were significantly higher in Group-1 than Group-2 (120 ± 15 vs. 96 ± 10 ms and 47 ± 12 vs. 25 ± 7 ms, respectively; p < 0.001 for both). P min didn't differ significantly. A P max value of ≥ 103 ms separated Group-1 from Group-2 with a sensitivity of 84.2%, specificity of 72.9%, positive predictive value of 50%, and negative predictive value of 93.5%. A P d value of ≥ 32.5 ms separated Group-1 from Group-2 with a sensitivity of 89.5%, specificity of 84.7%, positive predictive value of 65.4%, and negative predictive value of 96.2%. P max (p < 0.010) and P d (p < 0.001) were found to be significant univariate predictors of PAF, whereas only P d remained significant in multivariate analysis (p = 0.037).

Conclusion: P d ≥ 32.5 ms and P max ≥ 103.0 ms predict the recurrence of PAF after ablation with acceptable positive and negative predictive values. P d ≥ 32.5 ms is an independent predictor of recurrence of PAF after catheter ablation in patients with WPW syndrome.

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References

  1. Klein GJ, Bashore TM, Sellers TD, Pritchett EL, Smith WM, Gallagher JJ. Ventricular fibrillation in the Wolff-Parkinson-White syndrome. N Engl J Med 1979;301:1080–1085.

    Google Scholar 

  2. Montoya PT, Brugada P, Smeets J, Talajic M, Della Bella P, Lezaun R, vd Dool A, Wellens HJ, Bayes de Luna A, Oter R. Ventricular fibrillation in the Wolff-Parkinson-White syndrome. Eur Heart J 1991;12:144–150.

    Google Scholar 

  3. Hamada T, Hiraki T, Ikeda H, Kubara I, Yoshida T, Ohga M, Imaizumi T. Mechanisms for atrial fibrillation in patients withWolff-Parkinson-White syndrome. J Cardiovasc Electrophysiol 2002;13:223–229.

    Google Scholar 

  4. Haissaguerre M, Fischer B, Labbe T, Lemetayer P, Montserrat P, d'Ivernois C, Dartigues JF, Warin JF. Frequency of recurrent atrial fibrillation after catheter ablation of overt accessory pathways. Am J Cardiol 1992;69:493–497.

    Google Scholar 

  5. Maia IG, Cruz Filho FE, Fagundes ML, Boghossian SH, Vanheusden L, Sa RM, Alves PA. Signal-averaged P-wave in patients with Wolff-Parkinson-White syndrome after successful radiofrequency catheter ablation. J Am Coll Cardiol 1995;26:1310–1314.

    Google Scholar 

  6. Dilaveris PE, Gialafos EJ, Sideris SK, Theopistou AM, Andrikopoulos GK, Kyriakidis M, Gialafos JE, Toutouzas PK. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 1998;135:733–738.

    Google Scholar 

  7. Dilaveris PE, Gialafos JE. P-wave dispersion: A novel predictor of paroxysmal atrial fibrillation. Ann Noninvasive Electrocardiol 2001;6:159–165.

    Google Scholar 

  8. Knight BP, Morady F. Catheter ablation of accessory pathways. Cardiol Clin 1997;15:647–660.

    Google Scholar 

  9. Kose S, Aytemir K, Can I, Iyisoy A, Kilic A, Amasyali B, Kursaklioglu H, Isik E, Oto A, Demirtas E. Seasonal variation of P-wave dispersion in healthy subjects. J Electrocardiol 2002;35:307–311.

    Google Scholar 

  10. Kose S, Iyisoy A, Kursaklioglu H. Radiofrequency catheter ablation of an accessory pathway during preexcited atrial fibrillation. Acta Cardiol 2003;58:159–162.

    Google Scholar 

  11. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: The Framingham Study. Stroke 1991;22:983–988.

    Google Scholar 

  12. Flegel KM, Shipley MJ, Rose G. Risk of stroke in nonrheumatic atrial fibrillation. Lancet 1987;1:526–529.

    Google Scholar 

  13. Hiraki T, Ikeda H, Yoshida T, Inage T, Ohe M, Ohtsubo H, Matsumoto M, Hamada T, Kubara I, Imaizumi T. P wave signal-averaged electrocardiography predicts recurrence of paroxysmal atrial fibrillation in patients with Wolff-Parkinson-White syndrome who underwent successful catheter ablation: A prospective study. J Cardiovasc Electrophysiol 2002;13:1003–1008.

    Google Scholar 

  14. Waspe LE, Brodman R, Kim SG, Fisher JD. Susceptibility to atrial fibrillation and ventricular tachyarrhythmia in theWolff-Parkinson-White syndrome: role of the accessory pathway. Am Heart J 1986;112:1141–1152.

    Google Scholar 

  15. Aytemir K, Ozer N, Atalar E, Sade E, Aksoyek S, Ovunc K, Oto A, Ozmen F, Kes S. P wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2000;23:1109–1112.

    Google Scholar 

  16. Sharma AD, Klein GJ, Guiraudon GM, Milstein S. Atrial fibrillation in patients with Wolff-Parkinson-White syndrome: Incidence after surgical ablation of the accessory pathway. Circulation 1985;72:161–169.

    Google Scholar 

  17. Oddsson H, Edvardsson N, Walfridsson H. Episodes of atrial fibrillation and atrial vulnerability after successful radiofrequency catheter ablation in patients with Wolff-Parkinson-White syndrome. Europace 2002;4:201–206.

    Google Scholar 

  18. Hindricks G, Kottkamp H, Chen X, Willems S, Breithardt G, Borggrefe M. Successful radiofrequency catheter ablation of right sided accessory pathways during sustained atrial fibrillation. Eur Heart J 1995;16:967–970.

    Google Scholar 

  19. Sung RJ, Castellanos A, Mallon SM, Bloom MG, Gelband H, Myerburg RJ. Mechanisms of spontaneous alternation between reciprocating tachycardia and atrial flutter-fibrillation in theWolff-Parkinson-White syndrome. Circulation 1977;56:409–416.

    Google Scholar 

  20. Fujimura O, Klein GJ, Yee R, Sharma AD. Mode of onset of atrial fibrillation in the Wolff-Parkinson-White syndrome: How important is the accessory pathway? J Am Coll Cardiol 1990;15:1082–1086.

    Google Scholar 

  21. Konoe A, Fukatani M, Tanigawa M, Isomoto S, Kadena M, Sakamoto T, Mori M, Shimizu A, Hashiba K. Electrophysiological abnormalities of the atrial muscle in patients with manifest Wolff-Parkinson-White syndrome associated with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 1992;15:1040–1052.

    Google Scholar 

  22. Coumel P. Autonomic influences in atrial tachyarrhythmias. J Cardiovasc Electrophysiol 1996;7:999–1007.

    Google Scholar 

  23. Coumel P. The role of autonomic nervous system in atrial flutter and fibrillation: Clinical findings. In: Saoudi N, Schels W, El-Sherif N, eds. Atrial Flutter and Fibrillation: From Basic to Clinical Applications. Armonk, NY: Futura Publishing, 1998: 89–103.

    Google Scholar 

  24. Asano Y, Kaneko K, Matsumoto K, Saito J, Yamamoto T, Dohi Y. Atrial fibrillation and atrial vulnerability in the Wolff-Parkinson-White syndrome. Jpn Circ J 1991;55:287–296.

    Google Scholar 

  25. Engel TR, Luck JC, Leddy CL, Gonzalez AD. Diagnostic implications of atrial vulnerability. Pacing Clin Electrophysiol 1979;2:208–214.

    Google Scholar 

  26. Rinne C, Klein GJ, Sharma AD, Yee R, Milstein S, Rattes MF. Relation between clinical presentation and induced arrhythmias in the Wolff-Parkinson-White syndrome. Am J Cardiol 1987;60:576–579.

    Google Scholar 

  27. Yee R, Klein G, Guiraudon G. The Wolf-Parkinson-White syndrome. In: Zipes DP, Jalife J, eds. Cardiac Electrophysiology: From Cell to Bedside. Philadelphia: WB Saunders, 1995:1199–1214.

    Google Scholar 

  28. Fareh S, Villemaire C, Nattel S. Importance of refractoriness heterogeneity in the enhanced vulnerability to atrial fibrillation induction caused by tachycardia-induced atrial electrical remodeling. Circulation 1998;98:2202–2209.

    Google Scholar 

  29. Dagres N, Clague JR, Lottkamp H, Hindricks G, Breithardt G, Borggrefe M. Impact of radiofrequency catheter ablation of accessory pathways on the frequency of atrial fibrillation during long-term follow-up; high recurrence rate of atrial fibrillation in patients older than 50 years of age. Eur Heart J 2001;22:423–427.

    Google Scholar 

  30. Kose S, Aytemir K, Sade E, Can I, Ozer N, Amasyali B, Aksoyek S, Ovunc K, Ozmen F, Atalar E, Isik E, Kes S, Demitras E, Oto A. Detection of patients with hypertrophic cardiomyopathy at risk for paroxysmal atrial fibrillation during sinus rhythm by P-wave dispersion. Clin Cardiol 2003;26:431–434.

    Google Scholar 

  31. Ozer N, Aytemir K, Atalar E, Sade E, Aksoyek S, Ovunc K, Acyl T, Nazly N, Ozmen F, Oto A, Kes S. P wave dispersion in hypertensive patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2000;23(11 Pt 2):1859–1862.

    Google Scholar 

  32. Weber UK, Osswald S, Huber M, Buser P, Skarvan K, Stulz P, Schmidhauser C, Pfisterer M. Selective versus non-selective antiarrhythmic approach for prevention of atrial fibrillation after coronary surgery: Is there a need for pre-operative risk stratification? A prospective placebocontrolled study using low-dose sotalol. Eur Heart J 1998;19:794–800.

    Google Scholar 

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Authors and Affiliations

  1. Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Kudret Aytemir, Gulcan Abali & Ali Oto

  2. Department of Cardiology, Gulhane Military Medical Academy, Ankara, Turkey

    Basri Amasyali, Sedat Kose, Ayhan Kilic & Ersoy Isik

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  1. Kudret Aytemir
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  2. Basri Amasyali
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  3. Sedat Kose
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Aytemir, K., Amasyali, B., Kose, S. et al. Maximum P-Wave Duration and P-Wave Dispersion Predict Recurrence of Paroxysmal Atrial Fibrillation in Patients with Wolff-Parkinson-White Syndrome after Successful Radiofrequency Catheter Ablation. J Interv Card Electrophysiol 11, 21–27 (2004). https://doi.org/10.1023/B:JICE.0000035925.90831.80

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