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The effect of high-power short-duration pulmonary vein isolation on PWPT—a predictor of paroxysmal atrial fibrillation

Auswirkung der Hochenergie-Kurzzeit-Pulmonalvenenisolation auf die PWPT als einem Prädiktor des paroxysmalen Vorhofflimmerns

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Abstract

Background

The P wave peak time (PWPT) is a predictor of paroxysmal atrial fibrillation (PAF). High-power short-duration ablation has been associated with improved durability of circumferential pulmonary vein electrical isolation (PVI). We investigated the effect of high-power short-duration PVI on PWPT in patients with PAF.

Methods

Out of 111 patients with PAF, 91 received radiofrequency ablation (ablation group) and 20 received medication treatment (control group). A VIZIGO sheath and an STSF catheter (Biosense Webster, CA, USA) were used together for high-power short-duration circumferential PVI at ablation index values of 500 and 400 for the anterior and posterior walls, respectively. The patients were followed up for 12 months.

Results

The preoperative PWPT in the ablation group was similar to that in the control group: PWPT II = 54.38 ± 6.18 ms vs. 54.35 ± 6.12 ms (p > 0.05), PWPT V1 = 54.19 ± 6.21 ms vs. 54.31 ± 6.08 ms (p > 0.05), respectively. Circumferential PVI was achieved for all patients in the ablation group during the operation. At the 12-month follow-up, there were seven cases of AF recurrence. The PWPT in the ablation group 12 months postoperatively was shorter than the preoperative value: PWPT II = 49.39 ± 7.11 ms vs. 54.38 ± 6.18 ms (p < 0.001), PWPT V1 = 47.69 ± 7.01 ms vs. 54.19 ± 6.21 ms (p < 0.001). The PWPT in the patients with AF recurrence was significantly longer than that in the non-recurrence patients: PWPT II = 50.48 ± 7.12 ms vs. 47.33 ± 6.21 ms (p < 0.001), PWPT V1 = 50.84 ± 7.05 ms vs. 47.19 ± 6.27 ms, (p < 0.001). The PWPT of the control group at the 12-month follow-up was similar to the baseline level: PWPT II = 54.32 ± 6.20 ms vs. 54.35 ± 6.12 ms (p > 0.05), PWPT V1 = 53.89 ± 6.01 ms vs. 54.31 ± 6.08 ms (p > 0.05).

Conclusion

The results showed that high-power short-duration PVI had a positive effect on PWPT, which is a predictor of PAF.

Zusammenfassung

Hintergrund

Die Zeitdauer vom Beginn bis zum Gipfel der P‑Welle („P wave peak time“, PWPT) ist ein Prädiktor des paroxysmalen Vorhofflimmerns (PVF). Die Hochenergie-Kurzzeit-Ablation wurde mit einer besseren Dauerhaftigkeit der zirkumferenziellen elektrischen Pulmonalvenenisolation (PVI) in Verbindung gebracht. In der vorliegenden Arbeit wurde die Auswirkung der Hochenergie-Kurzzeit-PVI auf die PWPT bei Patienten mit PVF untersucht.

Methoden

Von 111 Patienten mit PAF erhielten 91 eine Behandlung mittels Radiofrequenzablation (Ablationsgruppe) und 20 eine medikamentöse Therapie (Kontrollgruppe). Ein VIZIGO-Schleuse (Fa. Biosense Webster, Irvine, CA, USA) und ein Smart-Touch-Surround-Flow(STSF)-Katheter (Fa. Biosense Webster) wurden zusammen für die zirkumferenzielle Hochenergie-Kurzzeit-PVI mit Ablationsindexwerten von 500 bzw. 400 für die Vorder- und Hinterwand verwendet. Die Patienten wurden 12 Monate lang nachbeobachtet.

Ergebnisse

Die präoperative PWPT in der Ablationsgruppe war ähnlich wie die in der Kontrollgruppe: PWPT II = 54,38 ± 6,18 ms vs. 54,35 ± 6,12 ms (p > 0,05) bzw. PWPT V1 = 54,19 ± 6,21 ms vs. 54,31 ± 6,08 ms (p > 0,05). Bei sämtlichen Patienten in der Ablationsgruppe wurde eine zirkumferenzielle PVI während der Operation erzielt. Beim 12-Monats-Follow-up gab es 7 Fälle mit Wiederauftreten des VF. Die PWPT in der Ablationsgruppe war 12 Monate postoperativ kürzer als der präoperative Wert: PWPT II = 49,39 ± 7,11 ms vs. 54,38 ± 6,18 ms (p < 0,001); PWPT V1 = 47,69 ± 7,01 ms vs. 54,19 ± 6,21 ms (p < 0,001). Die PWPT bei den Patienten mit VF-Rezidiv war signifikant länger als die bei den Patienten ohne VF-Rezidiv: PWPT II = 50,48 ± 7,12 ms vs. 47,33 ± 6,21 ms (p < 0,001); PWPT V1 = 50,84 ± 7,05 ms vs. 47,19 ± 6,27 ms; (p < 0,001). In der Kontrollgruppe war die PWPT beim 12-Monats-Follow-up ähnlich wie der Ausgangswert: PWPT II = 54,32 ± 6,20 ms vs. 54,35 ± 6,12 ms (p > 0,05); PWPT V1 = 53,89 ± 6,01 ms vs. 54,31 ± 6,08 ms (p > 0,05).

Schlussfolgerung

Den Ergebnissen zufolge hat die Hochenergie-Kurzzeit-PVI positive Auswirkungen auf die PWPT, die einen Prädiktor für PVF darstellt.

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Funding

This work was supported in part by the Cultivation Plan of Clinical Research, Second Affiliated Hospital of Anhui Medical University (2021LCYB19), and the Scientific Research Foundation of Education Department of Anhui Province of China (2022AH050658).

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Authors and Affiliations

  1. Department of Cardiology, The Second Affiliated Hospital of Anhui Medical University, 230601, Hefei, China

    Meng Wang, Xiaochen Wang, Feng Gao, Pei Bao & Zheng Huang

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  1. Meng Wang
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  2. Xiaochen Wang
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  3. Feng Gao
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Contributions

Meng Wang and Xiaochen Wang contributed to the conception and design. Meng Wang and Pei Bao contributed to the acquisition, analysis, and interpretation of the data, and the drafting of the article. Meng Wang, Zheng Huang, and Xiaochen Wang revised the article for intellectual content. Meng Wang, Xiaochen Wang, and Feng Gao finally approved the completed article.

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Correspondence to Meng Wang.

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Conflict of interest

M. Wang, X. Wang, F. Gao, P. Bao and Z. Huang declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.

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Wang, M., Wang, X., Gao, F. et al. The effect of high-power short-duration pulmonary vein isolation on PWPT—a predictor of paroxysmal atrial fibrillation. Herz 49, 69–74 (2024). https://doi.org/10.1007/s00059-023-05198-y

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  • DOI: https://doi.org/10.1007/s00059-023-05198-y

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