The characteristic of an abnormal p-wave axis in patients with atrial fibrillation.

BACKGROUNDS: An adverse increased risk of atrial fibrillation (AF) can be detected by measuring the p-wave indices, including prolonged p-wave duration, the PR interval, abnormal p-wave terminal force, and abnormal p-wave axis (aPWA). Our purpose was to characterize the AF patient population with an aPWA and to identify whether the aPWA was associated with recurrence after catheter ablation of AF. METHODS: This study retrospectively included 249 patients with AF who underwent catheter ablation in our hospital from October 2015 to May 2019. We measured the p-wave indices and left atrial cavity size (LAVI) before the catheter ablation. A logistic regression analysis was performed to analyze the concurrent effects of various factors on the prevalence of AF recurrence over 12 months after the ablation. RESULTS: An aPWA was observed in 35 patients (14%). There were significantly more patients with an aPWA in the non-PAF than PAF patients (26% versus 7%, p < 0.001). The patients with an aPWA had a significantly larger LAVI values (37 ± 12 versus 45 ± 11 ml/m2, p = 0.016). In a multivariate analysis, an aPWA (odds ratio, 4.27; 95% confidence interval, 1.75-10.4; p = 0.001) and the LAVI (odds ratio, 1.04; 95% confidence interval, 1.00-1.08; p = 0.032) were independently associated with recurrence after catheter ablation. CONCLUSIONS: Our results demonstrated that measuring the aPWA in patients with atrial fibrillation before ablation was useful for identifying patients at a higher risk of recurrence after catheter ablation of AF.

Can an increase in the pulmonary vein volume measured by three dimensional computed tomography predict the presence of atrial fibrillation?

BACKGROUND: Left atrial (LA) dilation is associated with morbidity of atrial fibrillation (AF). However, little is known about pulmonary vein (PV) dilation. PURPOSE: We investigated the PV volume in the patients with AF. METHODS AND RESULTS: We performed 3dimensional computed tomography (3DCT) in 155 patients and divided them into three groups: 19 patients without AF (non-AF group, mean age 66 ± 12 years), 50 with paroxysmal AF (PAF group, mean age 67 ± 8 years) and 24 with persistent AF (PeAF group, mean age 64 ± 10 years). The absence of AF was diagnosed in patients with a cardiac implantable electronic device for at least 1 year (mean: 59 ± 37 months). We determined the PV volume as the total volume from the orifice to the first branch of each PV. According to the echocardiographic data, the LA dimension (LAD) and LA volume index (LAVI) were largest in the PeAF group followed by the PAF and non-AF group. According to the morphometric data obtained on 3D-CT, the PV volume was similar in PeAF and PAF groups but significantly smaller in the non-AF group (median value: 24 vs 21 vs 14 mL, respectively). According to the receiver operating characteristic curve analysis, the area under the curve for the PV volume in the presence of AF was 0.80, and the optimum cut-off value was 17 mL (sensitivity 74%, specificity 80%). CONCLUSION: The PV volume might be useful for predicting the presence of AF before increases in the LAD and LAVI on echocardiography.