P-wave terminal force is related to left pulmonary vein reconnection in patients with atrial fibrillation recurrence after pulmonary vein isolation.

ABSTRACT

In patients with atrial fibrillation (AF) recurrence after pulmonary vein (PV) isolation, noninvasive markers predicting PV reconnection or PV reconnection sites have not been fully elucidated. This study investigated the relationship between the P-wave terminal force in lead V1 (PTFV1) and the PV reconnection or reconnection site in patients with AF recurrence. We retrospectively studied consecutive patients who underwent second AF ablation between April 1, 2018, and June 1, 2023. PTFV1 was investigated before the first AF ablation (pre-ablation PTFV1) and before the second AF ablation (post-ablation PTFV1). In addition, we examined the ratio of the post-ablation to pre-ablation PTFV1 (PTFV1 ratio). These values were compared between patients with and without PV reconnection, with and without left PV (LPV) reconnection, and with and without right PV (RPV) reconnection. The analysis included 56 patients. PTFV1 was reduced because of the first AF ablation. In addition, the values were more decreased in patients without PV reconnection than with PV reconnection. The PTFV1 ratio was significantly smaller in the patients without LPV reconnection than with LPV reconnection; no significant difference was observed between the patients with and without RPV reconnection. Receiver operating characteristic curve analysis showed that a PTFV1 ratio > 0.69 predicted LPV reconnection with 70.0% sensitivity and 66.7% specificity. In conclusion, the PTFV1 ratio may be a noninvasive marker predicting LPV reconnection in patients with AF recurrence.