Document Detail

Prediction of the efficacy of pulmonary vein isolation for the treatment of atrial fibrillation by the signal-averaged P-wave duration.
MedLine Citation:
PMID:  17367349     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The noninvasive methods for predicting a successful pulmonary vein isolation (PVI) have not been well described. The aim of this study was to assess the usefulness of the P-wave signal-averaged electrocardiogram (P-SAECG) in predicting the chance of a successful PVI in patients with atrial fibrillation (AF). METHODS: A P-SAECG was recorded before (pre), 1 day after, and 3-4 months after the PVI in 51 AF patients (41, paroxysmal AF; 10, persistent AF). Three-dimensional electroanatomic mapping (3D-EAM) of the right and left atria and left PVs was performed before PVI in 10 patients to analyze the biatrial conduction time (BAT). RESULTS: Fifteen patients suffered from AF recurrences 3 months or more after the PVI. The pre-filtered P-wave duration (FPD) was significantly longer in patients with recurrence than in those without (166.8 +/- 14.8 ms vs 145.9 +/- 12.6 ms, P < 0.0001). In both patient groups, PVI shortened the FPD, which continued for 3-4 months. Multivariate analysis revealed that a pre-FPD >150 ms was a powerful predictor for recurrence, but persistent AF, the left atrial dimension, and structural heart disease were not predictors for recurrence. 3D-EAM showed that the delayed activation point was located within the left PVs and the BAT was identical to the pre-FPD. CONCLUSIONS: The pre-FPD may strongly reflect atrial dysfunction, and thus may be useful for predicting a successful PVI. Shortening of the FPD after the PVI and similar FPD and BAT values suggest that the last component of the FPD represents the activation of the left PVs.
Yasuo Okumura; Ichiro Watanabe; Kimie Ohkubo; Sonoko Ashino; Masayoshi Kofune; Kenichi Hashimoto; Atsushi Shindo; Hidezou Sugimura; Toshiko Nakai; Yuji Kasamaki; Satoshi Saito
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Publication Detail:
Type:  Controlled Clinical Trial; Journal Article    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  30     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-03-19     Completed Date:  2007-05-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  304-13     Citation Subset:  IM    
Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
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MeSH Terms
Aged, 80 and over
Atrial Fibrillation / diagnosis*,  surgery*
Diagnosis, Computer-Assisted / methods*
Electrocardiography / methods*
Heart Conduction System / surgery*
Middle Aged
Pulmonary Veins / surgery*
Reproducibility of Results
Sensitivity and Specificity
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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