Background

It remains unknown whether P wave duration (PWD) ≥ 150 ms measured after extensive radiofrequency catheter ablation (RFCA) can identify non-paroxysmal atrial fibrillation (non-PAF) patients at increased risk of atrial tachyarrhythmia recurrence. We investigated the predicting power of PWD and its association with left atrial (LA) reverse remodeling in patients with non-PAF undergoing pulmonary vein isolation with LA linear ablation.

Methods

We retrospectively evaluated 136 patients who underwent RFCA for drug-refractory non-PAF. Electroanatomic mapping was acquired during AF. Low-voltage area (LVA) was defined as an area with bipolar voltage ≤0.5 mV. Electrocardiography and echocardiography were performed during sinus rhythm 1 day and 3 months after RFCA. PWD was measured using amplified 12‑lead electrocardiography. Prolonged PWD was defined as maximum PWD ≥ 150 ms.

Results

Over a mean follow-up duration of 48 ± 35 months, 28 patients experienced atrial tachyarrhythmia recurrence. PWD was positively correlated with LVA (r = 0.527, p < 0.001) and inversely correlated with LA emptying fraction (r = −0.399, p < 0.001). PWD was shortened and LA emptying fraction (LAEF) was increased in patients without atrial tachyarrhythmia recurrence during follow-up. Atrial tachyarrhythmia-free survival was significantly more likely in patients without a prolonged PWD (83.5% vs 60.7%, p = 0.002). Multivariate analysis showed that LAEF and PWD were independent predictors of atrial tachyarrhythmia recurrence.

Conclusions

PWD ≥ 150 ms measured after RFCA can identify patients with non-PAF at increased risk of atrial tachyarrhythmia recurrence. PWD is correlated with LVA and LAEF and reflects LA reverse remodeling.

中文翻译：

---

P 波持续时间 ≥ 150 ms 预示着非阵发性心房颤动的左心房功能和消融结果不佳

背景

尚不清楚在广泛射频导管消融 (RFCA) 后测量的 P 波持续时间 (PWD) ≥ 150 ms 是否可以识别房性快速性心律失常复发风险增加的非阵发性房颤 (non-PAF) 患者。我们研究了 PWD 的预测能力及其与接受 LA 线性消融肺静脉隔离的非 PAF 患者的左心房 (LA) 逆重构的关联。

方法

我们回顾性评估了 136 名接受 RFCA 治疗的药物难治性非 PAF 患者。电解剖图是在 AF 期间获得的。低电压区（LVA）定义为双极电压≤0.5 mV的区域。在 RFCA 后 1 天和 3 个月，在窦性心律期间进行心电图和超声心动图检查。PWD 使用放大的 12 导联心电图测量。延长 PWD 定义为最大 PWD ≥ 150 ms。

结果

在平均 48 ± 35 个月的随访期间，28 名患者出现房性快速性心律失常复发。PWD 与 LVA 呈正相关（r  = 0.527，p  < 0.001），与 LA 排空分数呈负相关（r  = -0.399，p  < 0.001）。随访期间没有房性快速性心律失常复发的患者 PWD 缩短，LA 排空分数 (LAEF) 增加。在没有延长 PWD 的患者中，无房性快速性心律失常的生存率明显更高（83.5% 对 60.7%，p  = 0.002）。多变量分析显示 LAEF 和 PWD 是房性快速性心律失常复发的独立预测因子。

结论

RFCA 后测量的 PWD ≥ 150 ms 可以识别非 PAF 患者的房性快速性心律失常复发风险增加。PWD 与 LVA 和 LAEF 相关，反映了 LA 的逆重构。