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Impact of hybrid procedure on P wave duration for atrial fibrillation ablation

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

An Erratum to this article was published on 18 February 2015

Abstract

Aim

Hybrid procedure (HP) involves epicardial isolation of pulmonary vein and posterior wall of left atrium, and endocardial checking of lesions and touchups (if needed). We aimed at observing the effect of hybrid procedure on P wave duration (PWD), calculated automatically from surface ECG leads at start and end of HP, and also for relationship to atrial fibrillation (AF) recurrence at 9 months.

Methods

Forty-one patients (32 male; mean age, 58.4 ± 9.5 years) underwent HP, as first ever ablation. A new automated method was used for P wave segmentation and PWD estimation from recognizable P waves in ECG lead I or II before and after HP, based on fitting of each P wave by means of two Gaussian functions.

Results

Overall, PWD was significantly decreased after procedure (104.4 ± 25.1 ms vs. 84.7 ± 23.8 ms, p = 0.0151), especially in persistent AF patients (122.4 ± 32.2 ms vs. 85.6 ± 24.5 ms, p = 0.02). PWD preprocedure was significantly higher in persistent than in paroxysmal patients (122.4 ± 32.2 ms vs. 92.5 ± 17.9 ms, p = 0.0383). PWD was significantly decreased after procedure in prior electrical cardioverted patients (106.7 ± 30.5 ms vs. 84.7 ± 23.1 ms, p = 0.0353). After 9-month follow-up of 40 patients, HP-induced PWD decrease was significant for the 12 persistent patients without recurrence (122.4.1 ± 35.3 ms vs. 85.6 ± 22.0 ms, p = 0.0210).

Conclusion

Preprocedure PWD was higher for persistent than paroxysmal patients. HP reduced PWD significantly. Nine-month follow-up suggests that HP is successful in restoring and maintaining sinus rhythm. To individualize AF therapy, AF type-based selection of patients may be possible before procedure. Automated analysis of PWD from surface ECG is possible.

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References

  1. Go, A. S., Hylek, E. M., Phillips, K. A., Chang, Y., Henault, L. E., Selby, J. V., et al. (2001). Prevalence of diagnosed atrial fibrillation in adults. JAMA, the Journal of the American Medical Association, 285(18), 2370–2375.

    Article  CAS  Google Scholar 

  2. Lin, H. J., Wolf, P. A., Kelly-Hayes, M., Beiser, A. S., Kase, C. S., Benjamin, E. J., et al. (1996). Stroke severity in atrial fibrillation. The Framingham Study. Stroke, 27(10), 1760–1764.

  3. Jais, P., Cauchemez, B., Macle, L., Daoud, E., Khairy, P., Subbiah, R., et al. (2008). Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: The A4 study. Circulation, 118(24), 2498–2505.

  4. Calkins, H., Kuck, K. H., Cappato, R., Brugada, J., Camm, A. J., Chen, S. A., et al. (2012). 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Journal of Interventional Cardiac Electrophysiology, 33(2), 171–257.

  5. Pison, L., La Meir, M., van Opstal, J., Blaauw, Y., Maessen, J., & Crijns, H. J. (2012). Hybrid thoracoscopic surgical and transvenous catheter ablation of atrial fibrillation. Journal of the American College of Cardiology, 60(1), 54–61.

  6. La Meir, M., Gelsomino, S., Luca, F., Lorusso, R., Gensini, G. F., Pison, L., et al. (2012). Minimally invasive thoracoscopic hybrid treatment of lone atrial fibrillation: Early results of monopolar versus bipolar radiofrequency source. Interactive Cardiovascular and Thoracic Surgery, 14(4), 445–450.

  7. Blanche, C., Tran, N., Rigamonti, F., Burri, H., & Zimmermann, M. (2013). Value of P-wave signal averaging to predict atrial fibrillation recurrences after pulmonary vein isolation. Europace, 15(2), 198–204.

  8. Caldwell, J., Koppikar, S., Barake, W., Redfearn, D., Michael, K., Simpson, C., et al. (2013). Prolonged P-wave duration is associated with atrial fibrillation recurrence after successful pulmonary vein isolation for paroxysmal atrial fibrillation. Journal of Interventional Cardiac Electrophysiology.

  9. Ogawa, M., Kumagai, K., Vakulenko, M., Yasuda, T., Siegerman, C., Garfinkel, A., et al. (2007). Reduction of P-wave duration and successful pulmonary vein isolation in patients with atrial fibrillation. Journal of Cardiovascular Electrophysiology, 18(9), 931–938.

  10. Bunch, T. J., & Day, J. D. (2011). Achieving favorable very long-term outcomes after catheter ablation for atrial fibrillation: An exciting adventure or delusional quest? Journal of Cardiovascular Electrophysiology, 22(11), 1215–1216.

  11. Kumar, N., Pison, L., la Meir, M., & Maessen, J. (2013). Direct visualization of pulmonary vein stenosis after previous catheter ablation. Heart Rhythm.

  12. Kumar, N., Pison, L., La Meir, M., Maessen, J., & Crijns, H. J. (2014). Hybrid approach to atrial fibrillation ablation using bipolar radiofrequency devices epicardially and cryoballoon endocardially. Interactive Cardiovascular and Thoracic Surgery.

  13. Censi, F., Calcagnini, G., Ricci, C., Ricci, R. P., Santini, M., Grammatico, A., et al. (2007). P-wave morphology assessment by a gaussian functions-based model in atrial fibrillation patients. IEEE Transactions on Biomedical Engineering, 54(4), 663–672.

  14. Corino, V. D., Chouvarda, I., Maglaveras, N., & Mainardi, L. T. (2010).A beat-to-beat P wave analysis in healthy population. In Computing in Cardiology, 2010, (pp. 553-556). IEEE.

  15. Pan, J., & Tompkins, W. J. (1985). A real-time QRS detection algorithm. IEEE Transactions on Biomedical Engineering, 32(3), 230–236.

  16. Van Beeumen, K., Houben, R., Tavernier, R., Ketels, S., & Duytschaever, M. (2010). Changes in P-wave area and P-wave duration after circumferential pulmonary vein isolation. Europace, 12(6), 798–804.

  17. Okumura, Y., Watanabe, I., Ohkubo, K., Ashino, S., Kofune, M., Hashimoto, K., et al. (2007). Prediction of the efficacy of pulmonary vein isolation for the treatment of atrial fibrillation by the signal-averaged P-wave duration. Pacing and Clinical Electrophysiology, 30(3), 304–313.

  18. Budeus, M., Hennersdorf, M., Perings, C., & Strauer, B. E. (2004). The prediction of atrial fibrillation recurrence after electrical cardioversion with P wave signal averaged EKG. Zeitschrift für Kardiologie, 93(6), 474–478.

  19. Meir, M. L. (2014). Surgical options for treatment of atrial fibrillation. Annals of Cardiothoracic Surgery, 3(1), 30–37.

    PubMed Central  PubMed  Google Scholar 

  20. Kumar, N., Phan, K., Pison, L., & Maessen, J. (2014). Re: Clinical characteristics and prognostic significance of chronic obstructive pulmonary disease in patients with atrial fibrillation: Results from a multicenter atrial fibrillation registry study. Journal of the American Medical Directors Association.

  21. Kumar, N., Phan, K., Timmermans, C., Pison, L., Meir, M. L., Maessen, J., et al. (2014). Catheter ablation of atrial fibrillation: The missing links. European Heart Journal.

  22. Redfearn, D. P., Skanes, A. C., Gula, L. J., Griffith, M. J., Marshall, H. J., Stafford, P. J., et al. (2007). Noninvasive assessment of atrial substrate change after wide area circumferential ablation: A comparison with segmental pulmonary vein isolation. Annals of Noninvasive Electrocardiology, 12(4), 329–337.

  23. Lemery, R., Birnie, D., Tang, A. S., Green, M., Gollob, M., Hendry, M., et al. (2007). Normal atrial activation and voltage during sinus rhythm in the human heart: An endocardial and epicardial mapping study in patients with a history of atrial fibrillation. Journal of Cardiovascular Electrophysiology, 18(4), 402–408.

  24. Date, T., Yamane, T., Inada, K., Matsuo, S., Kanzaki, Y., Miyanaga, S., et al. (2007). The effects of pulmonary vein isolation on the morphology of p waves: The contribution of pulmonary vein muscle excitation to the formation of p waves. Pacing and Clinical Electrophysiology, 30(1), 93–101.

  25. Nassif, M., Krul, S. P., Driessen, A. H., Deneke, T., Wilde, A. A., de Bakker, J. M., et al. (2013). Electrocardiographic P wave changes after thoracoscopic pulmonary vein isolation for atrial fibrillation. Journal of Interventional Cardiac Electrophysiology, 37(3), 275–282.

  26. de Vos, C. B., Pisters, R., Nieuwlaat, R., Prins, M. H., Tieleman, R. G., Coelen, R. J., et al. (2010). Progression from paroxysmal to persistent atrial fibrillation clinical correlates and prognosis. Journal of the American College of Cardiology, 55(8), 725–731.

  27. Steinberg, B. A., Hellkamp, A. S., Lokhnygina, Y., Patel, M. R., Breithardt, G., Hankey, G. J., et al. (2014). Higher risk of death and stroke in patients with persistent vs. paroxysmal atrial fibrillation: Results from the ROCKET-AF Trial. European Heart Journal.

  28. Cappato, R., Calkins, H., Chen, S. A., Davies, W., Iesaka, Y., Kalman, J., et al. (2010). Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation. Arrhythmia and Electrophysiology, 3(1), 32–38.

  29. Tilz, R. R., Chun, K. R., Schmidt, B., Fuernkranz, A., Wissner, E., Koester, I., et al. (2010). Catheter ablation of long-standing persistent atrial fibrillation: A lesson from circumferential pulmonary vein isolation. Journal of Cardiovascular Electrophysiology, 21(10), 1085–1093.

  30. Udyavar, A. R., Huang, S. H., Chang, S. L., Lin, Y. J., Tai, C. T., Lo, L. W., et al. (2009). Acute effect of circumferential pulmonary vein isolation on left atrial substrate. Journal of Cardiovascular Electrophysiology, 20(7), 715–722.

  31. Gorenek, B., Birdane, A., Kudaiberdieva, G., Goktekin, O., Cavusoglu, Y., Unalir, A., et al. (2003). P wave amplitude and duration may predict immediate recurrence of atrial fibrillation after internal cardioversion. Annals of Noninvasive Electrocardiology, 8(3), 215–218.

  32. Burashnikov, A., Di Diego, J. M., Sicouri, S., Ferreiro, M., Carlsson, L., & Antzelevitch, C. (2008). Atrial-selective effects of chronic amiodarone in the management of atrial fibrillation. Heart Rhythm, 5(12), 1735–1742.

  33. Redfearn, D. P., Lane, J., Ward, K., & Stafford, P. J. (2006). High-resolution analysis of the surface P wave as a measure of atrial electrophysiological substrate. Annals of Noninvasive Electrocardiology, 11(1), 12–19.

  34. Dhala, A., Underwood, D., Leman, R., Madu, E., Baugh, D., Ozawa, Y., et al. (2002). Signal-averaged P-wave analysis of normal controls and patients with paroxysmal atrial fibrillation: A study in gender differences, age dependence, and reproducibility. Clinical Cardiology, 25(11), 525–531.

    Article  PubMed  Google Scholar 

  35. Fukunami, M., Yamada, T., Ohmori, M., Kumagai, K., Umemoto, K., Sakai, A., et al. (1991). Detection of patients at risk for paroxysmal atrial fibrillation during sinus rhythm by P wave-triggered signal-averaged electrocardiogram. Circulation, 83(1), 162–169.

    Article  CAS  PubMed  Google Scholar 

  36. Budeus, M., Wieneke, H., Sack, S., Erbel, R., & Perings, C. (2006). Long-term outcome after cardioversion of atrial fibrillation: Prediction of recurrence with P wave signal averaged ECG and chemoreflexsensitivity. International Journal of Cardiology, 112(3), 308–315.

  37. Opolski, G., Scislo, P., Stanislawska, J., Gorecki, A., Steckiewicz, R., & Torbicki, A. (1997). Detection of patients at risk for recurrence of atrial fibrillation after successful electrical cardioversion by signal-averaged P-wave ECG. International Journal of Cardiology, 60(2), 181–185.

    Article  CAS  PubMed  Google Scholar 

  38. Nakagawa, H., Aoyama, H., Beckman, K. J., Po, S. S., Wu, R., Lockwood, D., et al. (2004). Relation between pulmonary vein firing and extent of left atrial-pulmonary vein connection in patients with atrial fibrillation. Circulation, 109(12), 1523–1529.

    Article  PubMed  Google Scholar 

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Acknowledgments

We would like to thank Suzanne Philippens (RN) for helping us in retrieving clinical follow-up data.

Conflict of interest

Mark La Meir and Laurent Pison are consultants to Atricure.

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Authors and Affiliations

  1. Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht (CARIM), P. Debyelaan 25, PO Box 5800, 6202AZ, Maastricht, The Netherlands

    Narendra Kumar, Laurent Pison & Harry Crijns

  2. Department of Cardiac Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands

    Bart Maessen, Mark La Meir, Sandro Gelsomino & Jos Maessen

  3. Department of Physiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands

    Theo Lankveld

  4. Department of knowledge engineering, Maastricht University, Maastricht, The Netherlands

    Pietro Bonizzi

  5. Macquarie University and Westmead Hospital, Sydney Medical School, University of Sydney, Sydney, Australia

    Kevin Phan

  6. Department of Heart and Vessels, Careggi Hospital, Via Delle Oblate 1, 50134, Florence, Italy

    Sandro Gelsomino

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  1. Narendra Kumar
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Correspondence to Narendra Kumar.

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Kumar, N., Bonizzi, P., Pison, L. et al. Impact of hybrid procedure on P wave duration for atrial fibrillation ablation. J Interv Card Electrophysiol 42, 91–99 (2015). https://doi.org/10.1007/s10840-014-9969-9

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