TY - JOUR
T1 - Short P-wave duration is a marker of higher rate of atrial fibrillation recurrences after pulmonary vein isolation
T2 - New insights into the pathophysiological mechanisms through computer simulations
AU - Auricchio, Angelo
AU - Özkartal, Tardu
AU - Salghetti, Francesca
AU - Neumann, Laura
AU - Pezzuto, Simone
AU - Gharaviri, Ali
AU - Demarchi, Andrea
AU - Caputo, Maria Luce
AU - Regoli, François
AU - De Asmundis, Carlo
AU - Chierchia, Gian Battista
AU - Brugada, Pedro
AU - Klersy, Catherine
AU - Moccetti, Tiziano
AU - Schotten, Ulrich
AU - Conte, Giulio
N1 - Funding Information:
This work was supported by the Netherlands Heart Foundation (CVON2014-09, RACE V Reappraisal of Atrial Fibrillation: Interaction between hyperCoagulability, Electrical remodeling, and Vascular Destabilisation in the Progression of AF), the European Union (ITN Network Personalized Therapies for Atrial Fibrillation: a translational network: PersonalizeAF, grant 860974, CATCH ME: Characterizing Atrial fibrillation by Translating its Causes into Health Modifiers in the Elderly, No. 633196).
Funding Information:
Angelo Auricchio is a consultant to Boston Scientific, Backbeat, Biosense Webster, Cairdac, Corvia, Microport CRM, EPD-Philips, Radcliffe Publisher. He received speaker fees from Boston Scientific, Medtronic, and Microport. He participates in clinical trials sponsored by Boston Scientific, Medtronic, EPD-Philips. He has intellectual properties with Boston Scientific, Biosense Webster, and Microport CRM. Ulrich Schotten received consultancy fees or honoraria from Roche Diagnostics (Switzerland), EP Solutions Inc. (Switzerland), and Johnson & Johnson Medical Limited, (United Kingdom). He is co-founder and shareholder of YourRhythmics BV, a spin-off company of the University Maastricht. Giulio Conte has received a research grant (PZ00P3_180055) from the Swiss Science National Foundation (SNF). The remaining authors have no disclosures to report.
Publisher Copyright:
© 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021
Y1 - 2021
N2 - BACKGROUND: Short ECG P-wave duration has recently been demonstrated to be associated with higher risk of atrial fibrillation (AF). The aim of this study was to assess the rate of AF recurrence after pulmonary vein isolation in patients with a short P wave, and to mechanistically elucidate the observation by computer modeling. METHODS AND RESULTS: A total of 282 consecutive patients undergoing a first single-pulmonary vein isolation procedure for paroxysmal or persistent AF were included. Computational models studied the effect of adenosine and sodium conductance on action potential duration and P-wave duration (PWD). About 16% of the patients had a PWD of 110 ms or shorter (median PWD 126 ms, interquartile range, 115 ms–138 ms; range, 71 ms–180 ms). At Cox regression, PWD was significantly associated with AF recurrence (P=0.012). Patients with a PWD <110 ms (hazard ratio [HR], 2.20; 95% CI, 1.24–3.88; P=0.007) and patients with a PWD ≥140 (HR, 1.87, 95% CI, 1.06–3.30; P=0.031) had a nearly 2-fold increase in risk with respect to the other group. In the computational model, adenosine yielded a significant reduction of action potential duration 90 (52%) and PWD (7%). An increased sodium conductance (up to 200%) was robustly accompanied by an increase in conduction velocity (26%), a reduction in action potential duration 90 (28%), and PWD (22%). CONCLUSIONS: One out of 5 patients referred for pulmonary vein isolation has a short PWD which was associated with a higher rate of AF after the index procedure. Computer simulations suggest that shortening of atrial action potential duration leading to a faster atrial conduction may be the cause of this clinical observation.
AB - BACKGROUND: Short ECG P-wave duration has recently been demonstrated to be associated with higher risk of atrial fibrillation (AF). The aim of this study was to assess the rate of AF recurrence after pulmonary vein isolation in patients with a short P wave, and to mechanistically elucidate the observation by computer modeling. METHODS AND RESULTS: A total of 282 consecutive patients undergoing a first single-pulmonary vein isolation procedure for paroxysmal or persistent AF were included. Computational models studied the effect of adenosine and sodium conductance on action potential duration and P-wave duration (PWD). About 16% of the patients had a PWD of 110 ms or shorter (median PWD 126 ms, interquartile range, 115 ms–138 ms; range, 71 ms–180 ms). At Cox regression, PWD was significantly associated with AF recurrence (P=0.012). Patients with a PWD <110 ms (hazard ratio [HR], 2.20; 95% CI, 1.24–3.88; P=0.007) and patients with a PWD ≥140 (HR, 1.87, 95% CI, 1.06–3.30; P=0.031) had a nearly 2-fold increase in risk with respect to the other group. In the computational model, adenosine yielded a significant reduction of action potential duration 90 (52%) and PWD (7%). An increased sodium conductance (up to 200%) was robustly accompanied by an increase in conduction velocity (26%), a reduction in action potential duration 90 (28%), and PWD (22%). CONCLUSIONS: One out of 5 patients referred for pulmonary vein isolation has a short PWD which was associated with a higher rate of AF after the index procedure. Computer simulations suggest that shortening of atrial action potential duration leading to a faster atrial conduction may be the cause of this clinical observation.
KW - Atrial fibrillation
KW - Computer modelling
KW - Electrophysiology
KW - P wave
KW - Pulmonary vein isolation
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U2 - 10.1161/JAHA.120.018572
DO - 10.1161/JAHA.120.018572
M3 - Article
AN - SCOPUS:85099845450
VL - 10
SP - 1
EP - 14
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
SN - 2047-9980
IS - 2
M1 - e018572
ER -