Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Can J Cardiol. 2023 Oct;39(10):1421-1431. doi: 10.1016/j.cjca.2023.04.014. Epub 2023 Apr 25.
Atrial low-voltage areas (LVAs) in patients with atrial fibrillation increase the risk of atrial arrhythmia (AA) recurrence after pulmonary vein isolation (PVI). Contemporary LVA prediction scores (DR-FLASH, APPLE) do not include P-wave metrics. We aimed to evaluate the utility of P-wave duration/amplitude ratio (PWR) in quantifying LVA and predicting AA recurrence after PVI.
In 65 patients undergoing first-time PVI, 12-lead ECGs were recorded during sinus rhythm. PWR was calculated as the ratio between the longest P-wave duration and P-wave amplitude in lead I. High-resolution biatrial voltage maps were collected and LVAs included bipolar electrogram amplitudes < 0.5 mV or < 1.0 mV. An LVA quantification model was created with the use of clinical variables and PWR, and then validated in a separate cohort of 24 patients. Seventy-eight patients were followed for 12 months to evaluate AA recurrence.
PWR strongly correlated with left atrial (LA) (< 0.5 mV: r = 0.60; < 1.0 mV: r = 0.68; P < 0.001) and biatrial LVA (< 0.5 mV: r = 0.63; < 1.0 mV: r = 0.70; P < 0.001). Addition of PWR to clinical variables improved model quantification of LA LVA at the < 0.5 mV (adjusted R = 0.59 to 0.68) and < 1.0 mV (adjusted R = 0.59 to 0.74) cutoffs. In the validation cohort, PWR model-predicted LVA correlated strongly with measured LVA (< 0.5 mV: r = 0.78; < 1.0 mV: r = 0.81; P < 0.001). PWR model was superior to DR-FLASH (area under the receiver operating characteristic curve [AUC] 0.90 vs 0.78; P = 0.030) and APPLE (AUC 0.90 vs 0.67; P = 0.003) at detecting LA LVA and similar at predicting AA recurrence after PVI (AUC 0.67 vs 0.65 and 0.60).
Our novel PWR model accurately quantifies LVA and predicts AA recurrence after PVI. PWR model-predicted LVA may help guide patient selection for PVI.
心房颤动患者的心房低电压区（LVA）会增加肺静脉隔离（PVI）后心房心律失常（AA）复发的风险。目前的 LVA 预测评分（DR-FLASH、APPLE）不包括 P 波指标。我们旨在评估 P 波持续时间/幅度比（PWR）在量化 LVA 和预测 PVI 后 AA 复发中的效用。
在 65 例首次接受 PVI 的患者中，窦性心律时记录 12 导联心电图。PWR 计算为 I 导联中最长 P 波持续时间与 P 波幅度的比值。采集高分辨率双房电压图，LVA 包括双极电图幅度<0.5 mV 或<1.0 mV。使用临床变量和 PWR 建立 LVA 量化模型，并在 24 例患者的独立队列中进行验证。78 例患者随访 12 个月以评估 AA 复发情况。
PWR 与左心房（LA）（<0.5 mV：r=0.60；<1.0 mV：r=0.68；P<0.001）和双房 LVA（<0.5 mV：r=0.63；<1.0 mV：r=0.70；P<0.001）呈强相关。将 PWR 添加到临床变量中，可改善 LA LVA 在<0.5 mV（调整后的 R=0.59 至 0.68）和<1.0 mV（调整后的 R=0.59 至 0.74）截断值的模型量化。在验证队列中，PWR 模型预测的 LVA 与测量的 LVA 呈强相关（<0.5 mV：r=0.78；<1.0 mV：r=0.81；P<0.001）。PWR 模型优于 DR-FLASH（曲线下面积 [AUC] 0.90 与 0.78；P=0.030）和 APPLE（AUC 0.90 与 0.67；P=0.003），在检测 LA LVA 方面表现出色，在预测 PVI 后 AA 复发方面相似（AUC 0.67 与 0.65 和 0.60）。
我们的新型 PWR 模型可准确量化 LVA 并预测 PVI 后 AA 复发。PWR 模型预测的 LVA 可能有助于指导 PVI 患者的选择。
