TY - JOUR
T1 - Changes in P-wave morphology after pulmonary vein isolation
T2 - insights from computer simulations
AU - Saha, Mirabeau
AU - Conte, Giulio
AU - Caputo, Maria Luce
AU - Regoli, François
AU - Krause, Rolf
AU - Auricchio, Angelo
AU - Jacquemet, Vincent
N1 - Publisher Copyright:
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For Permissions, please email: [email protected].
PY - 2016/12/1
Y1 - 2016/12/1
N2 - AIMS: Apparently conflicting clinical measurements of P-wave duration (PWD) pre- vs. post-ablation have been reported. To assist the interpretation of these clinical data, we used a computer model of the atria and torso to simulate P waves before and after pulmonary vein (PV) isolation.METHODS AND RESULTS: Twenty ablation patterns were designed (segmental or ipsilateral ablation; five distances to PV sleeves; addition of a roof line or not). Possible PV reconnections were introduced as gaps in the ablation lines. PWD and area were measured during sinus rhythm in vectorcardiogram (VCG) magnitude signals and on the 16-lead ECG before and after ablation, and after PV reconnection. After PV isolation, biatrial activation time was prolonged by 0-5 ms without and by 48±5 ms with roof line. Yet PWD was shortened in lead V3 and V4 by up to 15 ms. The effect of ablation on P-wave morphology was stronger when larger PV areas were isolated. Segmental and ipsilateral PV isolation led to concordant results. P-wave area increased in V1 and decreased in V6. Changes in PWD and area on the VCG were sensitive to the threshold used for detecting the end of the P wave. The occurrence of PV reconnection was best identified on leads V3, V4, and V9.CONCLUSION: PV isolation and reconnection induced measurable changes on the 16-lead ECG that might be used to improve patient follow-up after ablation.
AB - AIMS: Apparently conflicting clinical measurements of P-wave duration (PWD) pre- vs. post-ablation have been reported. To assist the interpretation of these clinical data, we used a computer model of the atria and torso to simulate P waves before and after pulmonary vein (PV) isolation.METHODS AND RESULTS: Twenty ablation patterns were designed (segmental or ipsilateral ablation; five distances to PV sleeves; addition of a roof line or not). Possible PV reconnections were introduced as gaps in the ablation lines. PWD and area were measured during sinus rhythm in vectorcardiogram (VCG) magnitude signals and on the 16-lead ECG before and after ablation, and after PV reconnection. After PV isolation, biatrial activation time was prolonged by 0-5 ms without and by 48±5 ms with roof line. Yet PWD was shortened in lead V3 and V4 by up to 15 ms. The effect of ablation on P-wave morphology was stronger when larger PV areas were isolated. Segmental and ipsilateral PV isolation led to concordant results. P-wave area increased in V1 and decreased in V6. Changes in PWD and area on the VCG were sensitive to the threshold used for detecting the end of the P wave. The occurrence of PV reconnection was best identified on leads V3, V4, and V9.CONCLUSION: PV isolation and reconnection induced measurable changes on the 16-lead ECG that might be used to improve patient follow-up after ablation.
KW - Activation map
KW - Atrial fibrillation
KW - Catheter ablation
KW - Computer modelling
KW - P-wave morphology
KW - Pulmonary vein reconnection
UR - http://www.scopus.com/inward/record.url?scp=85044540751&partnerID=8YFLogxK
U2 - 10.1093/europace/euw348
DO - 10.1093/europace/euw348
M3 - Article
C2 - 28011828
AN - SCOPUS:85044540751
SN - 1099-5129
VL - 18
SP - iv23-iv34
JO - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
JF - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
ER -