Antoun Ibrahim, Li Xin, Vali Zakkariya, Koev Ivelin, Somani Riyaz, Ng G André
Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK.
Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester, UK.
Pacing Clin Electrophysiol. 2025 Jan;48(1):36-41. doi: 10.1111/pace.15128. Epub 2024 Dec 24.
Pulmonary vein isolation (PVI) has been established as an effective management option for symptomatic paroxysmal atrial fibrillation (PAF). We aimed to explore the role of P-wave parameters in a 12-lead electrocardiogram (ECG) in predicting the success of repeat PAF ablation.
We enrolled consecutive patients who underwent a second AF ablation procedure for PAF in a UK tertiary center after an index ablation conducted between 2018 and 2019 and a repeat ablation up to 2021. A digital 12-lead ECG was recorded with a 1-50-Hz bandpass filter applied. P-wave duration (PWD), P-wave voltage (PWV), P-wave dispersion (PWDisp), and P-wave terminal force in V1 (PTFV1) were measured before and after the procedure. Changes were correlated with the 12-month clinical outcome. Procedural success was freedom from ECG-documented AF up to 12 months following ablation.
Study criteria were satisfied by 72 patients, of which 43 (60%) had successful repeat PVI at 12 months. The mean age is 65, and 47 (65%) were males. The demographics were comparable between both study arms. PWD decreased after successful repeat ablations (136.7 to 124.6 ms, p = 0.01) and failed repeat ablations (135.4 to 125.3 ms, p = 0.009) without a significant change between both arms. PMV and PWDisp did not change significantly after both study arms. PTFV1 significantly decreased after successful repeat ablations (-3.1 to -4.4 mm.s, p = 0.005) without a significant change after failed ablations (-2.9 to -2.7 mm.s, p = 0.42). Changes were statistically significant between both arms (p = 0.004).
PTFV1 reduction following the second AF ablation was correlated with successful repeat AF ablation at 12 months.
肺静脉隔离术（PVI）已被确立为有症状的阵发性心房颤动（PAF）的一种有效治疗选择。我们旨在探讨12导联心电图（ECG）中的P波参数在预测PAF再次消融成功率方面的作用。
我们纳入了在英国一家三级中心接受PAF二次房颤消融手术的连续患者，这些患者在2018年至2019年期间接受了首次消融，并在2021年之前进行了再次消融。使用1 - 50 Hz带通滤波器记录数字12导联心电图。在手术前后测量P波时限（PWD）、P波电压（PWV）、P波离散度（PWDisp）和V1导联的P波终末电势（PTFV1）。变化与12个月的临床结局相关。手术成功定义为消融后12个月内无心电图记录的房颤。
72例患者符合研究标准，其中43例（60%）在12个月时再次PVI成功。平均年龄为65岁，47例（65%）为男性。两个研究组的人口统计学特征具有可比性。成功再次消融后PWD降低（从136.7毫秒降至124.6毫秒，p = 0.01），失败的再次消融后也降低（从135.4毫秒降至125.3毫秒，p = 0.009），两组之间无显著变化。两个研究组术后PMV和PWDisp均无显著变化。成功再次消融后PTFV1显著降低（从 - 3.1降至 - 4.4毫米·秒，p = 0.005），失败消融后无显著变化（从 - 2.9降至 - 2.7毫米·秒，p = 0.42）。两组之间的变化具有统计学意义（p = 0.004）。
第二次房颤消融后PTFV1降低与12个月时再次房颤消融成功相关。
