BioMIT.org, Electronic Engineering Department, Universitat Politecnica de Valencia, 46022 Valencia, Spain.
Clinical Medicine Department, Miguel Hernández University, 03202 Elche, Spain.
Sensors (Basel). 2021 Dec 31;22(1):290. doi: 10.3390/s22010290.
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 (PWD), duration of the first (PWDon-peak) and second (PWDpeak-off) P-wave halves, estimating RA and LA conduction, respectively. P-wave onset (PWon-R) or offset (PWoff-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. PWD was correlated with the remaining features. Only PWD (non-scaling: Δ=-9.84%, p=0.0085, scaling: Δ=-17.96%, p=0.0442) and PWDpeak-off (non-scaling: Δ=-22.03%, p=0.0250, scaling: Δ=-27.77%, p=0.0268) were decreased. Correlation of all features with PWD was significant before/after PVI (p<0.0001), showing the highest value between PWD and PWon-R (ρmax=0.855). PWD correlated more with PWDon-peak (ρ= 0.540-0.805) than PWDpeak-off (ρ= 0.419-0.710). PWD 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.
在阵发性心房颤动 (pAF) 的肺静脉隔离 (PVI) 后，可以通过分析心电图 (ECG) 中的 P 波持续时间来非侵入性地评估心房基质的改变。然而，右心房 (RA) 和左心房 (LA) 是否同样有助于这种现象尚不清楚。本研究将 P 波的基本特征分开，以研究不同的 RA 和 LA 对 P 波持续时间的贡献。对 29 例首次接受 PVI 的 pAF 患者进行了记录，并在 PVI 前后进行了记录。计算了 P 波特征：P 波持续时间 (PWD)、第一 (PWDon-peak) 和第二 (PWDpeak-off) 半 P 波的持续时间，分别估计 RA 和 LA 的传导。P 波起始 (PWon-R) 或终止 (PWoff-R) 到 R 波的间隔，分别测量心房/房室和单房室传导的综合和单一。心率波动通过缩放进行校正。用曼-惠特尼 U 检验比较 PVI 前后的结果。PWD 与其余特征相关。只有 PWD（非缩放：Δ=-9.84%，p=0.0085，缩放：Δ=-17.96%，p=0.0442）和 PWDpeak-off（非缩放：Δ=-22.03%，p=0.0250，缩放：Δ=-27.77%，p=0.0268）降低。PVI 前后所有特征与 PWD 的相关性均显著（p<0.0001），PWD 与 PWon-R 的相关性最高（ρmax=0.855）。PWD 与 PWDon-peak 的相关性大于 PWDpeak-off（ρ=0.540-0.805）。PVI 后 pAF 的 PWD 缩短主要来自 P 波的后半部分。因此，非侵入性估计 LA 传导时间对于研究 PVI 后心房基质的改变至关重要，并且应该通过分裂 P 波来解决，以实现更好的估计。
