The Value of P-Wave Parameters Changes in Predicting Catheter Ablation Outcomes for Paroxysmal Atrial Fibrillation

Background: Pulmonary vein isolation (PVI) is the most promising management method for paroxysmal atrial fibrillation (PAF). The P wave in the electrocardiogram (ECG) represents atrial depolarization. This study aims to correlate P-wave parameters after PVI with outcomes. Methods: This single-center retrospective study included consecutive patients with first-time PVI for PAF between 2018 and 2019 and targeted pulmonary veins (PVs). Procedure success was defined by freedom of ECG-documented AF at 12 months. Digital 12 leads ECGs with 1-50 hertz bandpass filter were monitored before the procedure. P-wave amplitude (PWA) and P-wave terminal force in V1 (PTFV1) Corrected P-wave duration (PWDc), and P-wave dispersion (PWDisp), were measured before and after ablation. Results: The final analysis included 180 patients, of which 130 (72%) had successful ablations and 53 (30%) had radiofrequency ablation (RF). Males comprised 71% of the patients; the mean age was 60. Demographics were similar between both arms p < 0.001. Patients with failed PVI had increased PWDc after PVI (139-146 ms, p < 0.001) compared to patients with successful PVI. PWA increased significantly after failed PVI (1.6-2 mV, p < 0.001) and successful PVI (1.6-1.8 mV, p = 0.008). PWD (hazard ratio [HR]: 2.5, 95% confidence interval [CI]: 1.4-4.2, p < 0.001) and PWA (HR: 1.7, 95% CI: 1.2-2.9, p = 0.03) were independently associated with PVI failure at 12 months. PWdisp and PTFV1 were not correlated with outcomes. Conclusion: Increased PWDc and PWA after PVI were independently associated with failed ablation for PAF, supporting the role of P-wave parameters in predicting outcomes.