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The Duration of the Amplified Sinus-P-wave Identifies Presence of Left Atrial Low Voltage Substrate and Predicts Outcome After Pulmonary Vein Isolation in Patients with Persistent Atrial Fibrillation

Amir S. JadidiBjörn Müller-EdenbornJuan ChenCornelius KeylReinhold WeberHans Jürgen AllgeierZoraida Moreno-WeidmannDietmar TrenkFranz-Josef NeumannHeiko LehrmannThomas Arentz

出版	Universität, 2018
URL	http://books.google.com.hk/books?id=-X5c0AEACAAJ&hl=&source=gbs_api

註釋

Abstract: Objectives
Left atrial (LA) low-voltage substrate (LVS) potentially slows intra-atrial conduction, which might identify patients at risk for arrhythmia recurrence following pulmonary vein isolation (PVI).

Background
Up to 50% of patients with persistent atrial fibrillation (AF) have arrhythmia recurrence following PVI, mostly due to arrhythmogenic LA LVS.

Methods
Seventy-two patients with persistent AF underwent electrocardioversion to sinus rhythm and high-density voltage mapping of the left atrium. Invasively measured LA activation time and P-wave duration (PWD; total PWD and LA PWD [measured from −dV/dt in leads V1 and V2 until the end of the P-wave]) on amplified (40 to 50 mm/mV, 100 to 200 mm/s) digitized 12-lead electrocardiography (ECG) were compared with the extent of LA LVS (0.5 and 1. 0mV). Freedom from arrhythmia following PVI was evaluated in 143 patients with persistent AF stratified according to amplified PWD before ablation.brbrResultsbrLA LVS resulted in regional conduction delay, which increased LA activation time (r = 0.79). LA PWD strongly correlated with LA activation time (r = 0.96) and LA LVS (r = 0.80). As the first (right atrial) portion of the P-wave (from P-wave beginning until −dV/dt in leads V1 and V2) was not affected by LA LVS, total PWD correlated with LA LVS (r = 0.84). PWD ≥150 ms identified advanced LA LVS with 94.3% sensitivity and 91.7% specificity. One-year arrhythmia freedom following PVI-only was significantly higher in patients with PWD 150 ms (n = 73) compared with those with prolonged PWD ≥150 ms (n = 70) (72.0% vs. 40.8%; p = 0.003).