P-wave indices as predictors of atrial fibrillation recurrence after pulmonary vein isolation in normal left atrial size.

Aims: Prolonged P-wave duration and dispersion are universally accepted noninvasive markers for atrial electrical remodeling. Our aim was to analyze P-wave indices as predictors of atrial fibrillation recurrence after pulmonary vein isolation in patients with normal left atrial size.

Methods: From January 2008 to December 2011, 426 patients with drug-resistant symptomatic paroxysmal atrial fibrillation underwent pulmonary vein isolation as an index procedure by conventional radiofrequency or cryoballoon ablation in our center. Patients with left atrial dilatation, poor-quality electrocardiograms, atrial pacemaker stimulation, and those undergoing repeat procedures were excluded. A total of 201 patients were analyzed during a mean follow-up of 22 ± 16 months.

Results: Patients with prolonged P-wave duration had higher rates of atrial fibrillation recurrences compared with those without prolonged P-wave duration (49 vs. 14%; P < 0.001). Atrial fibrillation recurrence was significantly associated with prolonged P-wave duration (129 ± 13 vs. 119 ± 11 ms; P < 0.001) and P-wave dispersion (54 ± 12 vs. 42 ± 10 ms; P < 0.001) compared with those who remained in sinus rhythm. P-wave duration and dispersion were independently associated with atrial fibrillation recurrence (hazard ratio 1.045, 95% confidence interval 1.027-1.063, P < 0.001; and hazard ratio 1.049, 95% confidence interval 1.022-1.078, P < 0.001, respectively), after adjusting for left atrial size and age.

Conclusion: Prolonged P-wave duration and dispersion were found to be independently associated with higher recurrence rates of atrial fibrillation after pulmonary vein isolation in patients with normal left atrial dimension. Therefore, a prolongation of P-wave indices may help to identify those patients in whom electrical remodeling has already occurred and a more extensive ablation may be indicated.