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- Title
Splitting the P-Wave: Improved Evaluation of Left Atrial Substrate Modification after Pulmonary Vein Isolation of Paroxysmal Atrial Fibrillation.
- Authors
Vraka, Aikaterini; Bertomeu-González, Vicente; Hornero, Fernando; Quesada, Aurelio; Alcaraz, Raúl; Rieta, José J.
- Abstract
Atrial substrate modification after pulmonary vein isolation (PVI) of paroxysmal atrial fibrillation (pAF) can be assessed non-invasively by analyzing P-wave duration in the electrocardiogram (ECG). However, whether right (RA) and left atrium (LA) contribute equally to this phenomenon remains unknown. The present study splits fundamental P-wave features to investigate the different RA and LA contributions to P-wave duration. Recordings of 29 pAF patients undergoing first-ever PVI were acquired before and after PVI. P-wave features were calculated: P-wave duration ( P W D ), duration of the first ( P W D o n - p e a k ) and second ( P W D p e a k - o f f ) P-wave halves, estimating RA and LA conduction, respectively. P-wave onset ( P W o n - R ) or offset ( P W o f f - R ) to R-peak interval, measuring combined atrial/atrioventricular and single atrioventricular conduction, respectively. Heart-rate fluctuation was corrected by scaling. Pre- and post-PVI results were compared with Mann–Whitney U-test. P W D was correlated with the remaining features. Only P W D (non-scaling: Δ = − 9.84 % , p = 0.0085 , scaling: Δ = − 17.96 % , p = 0.0442 ) and P W D p e a k - o f f (non-scaling: Δ = − 22.03 % , p = 0.0250 , scaling: Δ = − 27.77 % , p = 0.0268 ) were decreased. Correlation of all features with P W D was significant before/after PVI ( p < 0.0001 ), showing the highest value between P W D and P W o n - R ( ρ m a x = 0.855 ). P W D correlated more with P W D o n - p e a k ( ρ = 0.540–0.805) than P W D p e a k - o f f ( ρ = 0.419–0.710). P W D shortening after PVI of pAF stems mainly from the second half of the P-wave. Therefore, noninvasive estimation of LA conduction time is critical for the study of atrial substrate modification after PVI and should be addressed by splitting the P-wave in order to achieve improved estimations.
- Subjects
PULMONARY veins; ATRIAL fibrillation; LEFT heart atrium; ATRIAL arrhythmias
- Publication
Sensors (14248220), 2022, Vol 22, Issue 1, p290
- ISSN
1424-8220
- Publication type
Article
- DOI
10.3390/s22010290