Low P-wave amplitude (˂0.1 mV) in lead I is associated with displaced inter-atrial conduction and clinical recurrence of paroxysmal atrial fibrillation after radiofrequency catheter ablation

Abstract

Aims We hypothesized that P-wave amplitude in lead I is related to left atrial (LA) remodelling and inter-atrial conduction pattern, and has a predictive value for recurrence after radiofrequency catheter ablation (RFCA) among patients with paroxysmal atrial fibrillation (PAF). Methods and results A total of 525 consecutive patients with PAF (76% male, 56+12 years old) who underwent RFCA were included.We compared pre-procedural sinus rhythm electrocardiograms without antiarrhythmic drug effect with LAvolume (CT), LA voltage (NavX), the earliest activation site (EAS) conduction pattern of LA, and clinical recurrence rate. P-wave amplitude in lead Iwas significantly lower in patients with recurrence than in those that remained in sinus rhythm (P , 0.001) during 21+10-month follow-up. P-wave amplitude in lead I was linearly correlated with LA voltage (b ¼ 2.52, 95% CI 0.606– 4.425, P ¼ 0.010), LA conduction velocity (b ¼ 1.91, 95% CI 0.941–2.876, P , 0.001), and low septal displacement of EAS (b ¼ 21.67, 95% CI22.352 to20.996, P , 0.001). P-wave amplitudes,0.1 mVin lead I were independently associated with clinical recurrence of AF on multivariate Cox regression analysis (adjusted HR 2.163, 95% CI 1.307–3.581, P ¼ 0.003). The integrated area under the curves was 0.705 (95% CI 0.655–0.755). Conclusion Low P-wave amplitude (,0.1 mV) in lead I is related to LA remodelling and displaced inter-atrial conduction pattern to low septum, and independently predicts clinical recurrence after RFCA in patients with PAF.