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Short P-Wave Duration is a Marker of Higher Rate of Atrial Fibrillation Recurrences after Pulmonary Vein Isolation: New Insights into the Pathophysiological Mechanisms Through Computer Simulations.
Auricchio, Angelo; Özkartal, Tardu; Salghetti, Francesca; Neumann, Laura; Pezzuto, Simone; Gharaviri, Ali; Demarchi, Andrea; Caputo, Maria Luce; Regoli, François; De Asmundis, Carlo; Chierchia, Gian-Battista; Brugada, Pedro; Klersy, Catherine; Moccetti, Tiziano; Schotten, Ulrich; Conte, Giulio.
Afiliación
  • Auricchio A; Division of Cardiology Cardiocentro Ticino Lugano Switzerland.
  • Özkartal T; Center for Computational Medicine in Cardiology Università della Svizzera Italiana Lugano Switzerland.
  • Salghetti F; Division of Cardiology Cardiocentro Ticino Lugano Switzerland.
  • Neumann L; Department of Cardiology Ospedale San Giovanni Bellinzona Switzerland.
  • Pezzuto S; Heart Rhythm Management Centre Postgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium.
  • Gharaviri A; Division of Cardiology Cardiocentro Ticino Lugano Switzerland.
  • Demarchi A; Center for Computational Medicine in Cardiology Università della Svizzera Italiana Lugano Switzerland.
  • Caputo ML; Center for Computational Medicine in Cardiology Università della Svizzera Italiana Lugano Switzerland.
  • Regoli F; Division of Cardiology Cardiocentro Ticino Lugano Switzerland.
  • De Asmundis C; Division of Cardiology Cardiocentro Ticino Lugano Switzerland.
  • Chierchia GB; Division of Cardiology Cardiocentro Ticino Lugano Switzerland.
  • Brugada P; Heart Rhythm Management Centre Postgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium.
  • Klersy C; Heart Rhythm Management Centre Postgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium.
  • Moccetti T; Heart Rhythm Management Centre Postgraduate course in Cardiac Electrophysiology and PacingVrije Universiteit BrusselUniversitair Ziekenhuis Brussel Brussels Belgium.
  • Schotten U; Service of Clinical Epidemiology & Biometry Fondazione IRCCS Policlinico San Matteo Pavia Italy.
  • Conte G; Division of Cardiology Cardiocentro Ticino Lugano Switzerland.
J Am Heart Assoc ; 10(2): e018572, 2021 01 19.
Article en En | MEDLINE | ID: mdl-33410337
Background Short ECG P-wave duration has recently been demonstrated to be associated with higher risk of atrial fibrillation (AF). The aim of this study was to assess the rate of AF recurrence after pulmonary vein isolation in patients with a short P wave, and to mechanistically elucidate the observation by computer modeling. Methods and Results A total of 282 consecutive patients undergoing a first single-pulmonary vein isolation procedure for paroxysmal or persistent AF were included. Computational models studied the effect of adenosine and sodium conductance on action potential duration and P-wave duration (PWD). About 16% of the patients had a PWD of 110 ms or shorter (median PWD 126 ms, interquartile range, 115 ms-138 ms; range, 71 ms-180 ms). At Cox regression, PWD was significantly associated with AF recurrence (P=0.012). Patients with a PWD <110 ms (hazard ratio [HR], 2.20; 95% CI, 1.24-3.88; P=0.007) and patients with a PWD ≥140 (HR, 1.87, 95% CI, 1.06-3.30; P=0.031) had a nearly 2-fold increase in risk with respect to the other group. In the computational model, adenosine yielded a significant reduction of action potential duration 90 (52%) and PWD (7%). An increased sodium conductance (up to 200%) was robustly accompanied by an increase in conduction velocity (26%), a reduction in action potential duration 90 (28%), and PWD (22%). Conclusions One out of 5 patients referred for pulmonary vein isolation has a short PWD which was associated with a higher rate of AF after the index procedure. Computer simulations suggest that shortening of atrial action potential duration leading to a faster atrial conduction may be the cause of this clinical observation.
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Texto completo: 1 Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Fibrilación Atrial / Potenciales de Acción / Ablación por Catéter / Electrocardiografía / Sistema de Conducción Cardíaco Tipo de estudio: Diagnostic_studies / Etiology_studies / Prognostic_studies Límite: Female / Humans / Male / Middle aged Idioma: En Revista: J Am Heart Assoc Año: 2021 Tipo del documento: Article

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Fibrilación Atrial / Potenciales de Acción / Ablación por Catéter / Electrocardiografía / Sistema de Conducción Cardíaco Tipo de estudio: Diagnostic_studies / Etiology_studies / Prognostic_studies Límite: Female / Humans / Male / Middle aged Idioma: En Revista: J Am Heart Assoc Año: 2021 Tipo del documento: Article