A Predictive Model for Recurrence of Atrial Fibrillation Based on P-Wave Duration in Patients with Early Persistent Atrial Fibrillation Who Underwent Radiofrequency Catheter Ablation
DOI:
https://doi.org/10.59958/hsf.6993Keywords:
atrial fibrillation, P-wave duration, radiofrequency catheter ablation, predictive model, echocardiographyAbstract
Purpose: To construct a predictive model for the recurrence of atrial fibrillation (AF) based on P-wave duration (PWD) in patients with early persistent AF (PeAF) who underwent radiofrequency catheter ablation (RFCA), with the aim of helping clinicians accurately adjust clinical strategies. Methods: Data from patients with early PeAF, who were admitted to the Department of Cardiology at the authors' hospital were collected. Based on predefined inclusion and exclusion criteria, only those who successfully underwent RFCA for the first time were included in the analysis. Pre- and postoperative clinical, echocardiographic, and electrocardiographic data were collected and recorded. Multivariate logistic regression was used to construct a predictive model for AF recurrence based on PWD. The predictive efficacy of each continuous variable and the predictive model were compared using the area under the receiver operating characteristic (ROC) curve. The corresponding nomogram for the predictive model was constructed. Interaction tests were performed to evaluate the predictive efficacy of the model for AF recurrence. Results: A total of 237 patients were enrolled and divided into two groups: recurrence (n = 59); and sinus rhythm (n = 178). PWD was greater and left atrial appendage emptying velocity (LAAV) was lower in the recurrence group; these differences were statistically significant (p < 0.001). The ROC curve for univariate prediction of AF recurrence revealed that the area under the ROC curve (AUC) for PWD and LAAV were 0.7912 and 0.7713, respectively, which were greater than those of other continuous variables. Compared with PWD alone, the multivariate predictive model containing PWD, left ventricular ejection fraction, and LAAV demonstrated no statistically significant difference in AUC (p = 0.0553) but improved the prediction efficiency of correctly reclassifying recurrence rates, net reclassification improvement 14.13% (95% confidence interval: 0.19–28.07%; p = 0.0469). The interaction effect did not significantly alter the effectiveness of the predictive models. Conclusions: The multivariate model based on PWD measured after RFCA demonstrated better predictive efficacy than the univariate model in patients with early PeAF. These results may contribute to evidence supporting the formulation of personalised treatments for patients with AF.
References
Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal. 2021; 42: 373–498.
Lippi G, Sanchis-Gomar F, Cervellin G. Global epidemiology of atrial fibrillation: An increasing epidemic and public health challenge. International Journal of Stroke: Official Journal of the International Stroke Society. 2021; 16: 217–221.
Zhang J, Johnsen SP, Guo Y, Lip GYH. Epidemiology of Atrial Fibrillation: Geographic/Ecological Risk Factors, Age, Sex, Genetics. Cardiac Electrophysiology Clinics. 2021; 13: 1–23.
Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S. Epidemiology of atrial fibrillation: European perspective. Clinical Epidemiology. 2014; 6: 213–220.
Burdett P, Lip GYH. Atrial fibrillation in the UK: predicting costs of an emerging epidemic recognizing and forecasting the cost drivers of atrial fibrillation-related costs. European Heart Journal. Quality of Care & Clinical Outcomes. 2022; 8: 187–194.
Nieuwlaat R, Prins MH, Le Heuzey JY, Vardas PE, Aliot E, Santini M, et al. Prognosis, disease progression, and treatment of atrial fibrillation patients during 1 year: follow-up of the Euro Heart Survey on atrial fibrillation. European Heart Journal. 2008; 29: 1181–1189.
De Vos CB, Breithardt G, Camm AJ, Dorian P, Kowey PR, Le Heuzey JY, et al. Progression of atrial fibrillation in the REgistry on Cardiac rhythm disORDers assessing the control of Atrial Fibrillation cohort: clinical correlates and the effect of rhythm-control therapy. American Heart Journal. 2012; 163: 887–893.
Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017; 14: e275–e444.
Burstein B, Nattel S. Atrial fibrosis: mechanisms and clinical relevance in atrial fibrillation. Journal of the American College of Cardiology. 2008; 51: 802–809.
Tanigawa M, Fukatani M, Konoe A, Isomoto S, Kadena M, Hashiba K. Prolonged and fractionated right atrial electrograms during sinus rhythm in patients with paroxysmal atrial fibrillation and sick sinus node syndrome. Journal of the American College of Cardiology. 1991; 17: 403–408.
Caldwell J, Koppikar S, Barake W, Redfearn D, Michael K, Simpson C, et al. Prolonged P-wave duration is associated with atrial fibrillation recurrence after successful pulmonary vein isolation for paroxysmal atrial fibrillation. Journal of Interventional Cardiac Electrophysiology: an International Journal of Arrhythmias and Pacing. 2014; 39: 131–138.
Unkell M, Marinov M, Wolff PS, Radziejewska J, Mercik JS, Gajek J. P wave duration in paroxysmal and persistent atrial fibrillation. Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University. 2020; 29: 1347–1354.
Poole JE, Bahnson TD, Monahan KH, Johnson G, Rostami H, Silverstein AP, et al. Recurrence of Atrial Fibrillation After Catheter Ablation or Antiarrhythmic Drug Therapy in the CABANA Trial. Journal of the American College of Cardiology. 2020; 75: 3105–3118.
Miao Y, Xu M, Yang L, Zhang C, Liu H, Shao X. Investigating the association between P wave duration and atrial fibrillation recurrence after radiofrequency ablation in early persistent atrial fibrillation patients. International Journal of Cardiology. 2022; 351: 48–54.
Spencer KT, Mor-Avi V, Gorcsan J, 3rd, DeMaria AN, Kimball TR, Monaghan MJ, et al. Effects of aging on left atrial reservoir, conduit, and booster pump function: a multi-institution acoustic quantification study. Heart (British Cardiac Society). 2001; 85: 272–277.
DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988; 44: 837–845.
Miao Y, Xu M, Zhang C, Liu H, Shao X, Wang Y, et al. An echocardiographic model for predicting the recurrence of paroxysmal atrial fibrillation after circumferential pulmonary vein ablation. Clinical Cardiology. 2021; 44: 1506–1515.
Nielsen JB, Kühl JT, Pietersen A, Graff C, Lind B, Struijk JJ, et al. P-wave duration and the risk of atrial fibrillation: Results from the Copenhagen ECG Study. Heart Rhythm. 2015; 12: 1887–1895.
Aytemir K, Amasyali B, Kose S, Kilic A, Abali G, Oto A, et al. Maximum P-wave duration and P-wave dispersion predict recurrence of paroxysmal atrial fibrillation in patients with Wolff-Parkinson-White syndrome after successful radiofrequency catheter ablation. Journal of Interventional Cardiac Electrophysiology: an International Journal of Arrhythmias and Pacing. 2004; 11: 21–27.
Salah A, Zhou S, Liu Q, Yan H. P wave indices to predict atrial fibrillation recurrences post pulmonary vein isolation. Arquivos Brasileiros De Cardiologia. 2013; 101: 519–527.
Guo XH, Gallagher MM, Poloniecki J, Yi G, Camm AJ. Prognostic significance of serial P wave signal-averaged electrocardiograms following external electrical cardioversion for persistent atrial fibrillation: a prospective study. Pacing and Clinical Electrophysiology: PACE. 2003; 26: 299–304.
Raitt MH, Ingram KD, Thurman SM. Signal-averaged P wave duration predicts early recurrence of atrial fibrillation after cardioversion. Pacing and Clinical Electrophysiology: PACE. 2000; 23: 259–265.
Dogan A, Kahraman H, Ozturk M, Avsar A. P wave dispersion and left atrial appendage function for predicting recurrence after conversion of atrial fibrillation and relation of p wave dispersion to appendage function. Echocardiography (Mount Kisco, N.Y.). 2004; 21: 523–530.
Knecht S, Pradella M, Reichlin T, Mühl A, Bossard M, Stieltjes B, et al. Left atrial anatomy, atrial fibrillation burden, and P-wave duration-relationships and predictors for single-procedure success after pulmonary vein isolation. 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. 2018; 20: 271–278.
Platonov PG. P-wave morphology: underlying mechanisms and clinical implications. Annals of Noninvasive Electrocardiology: the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc. 2012; 17: 161–169.
Müller-Edenborn B, Chen J, Allgeier J, Didenko M, Moreno-Weidmann Z, Neumann FJ, et al. Amplified sinus-P-wave reveals localization and extent of left atrial low-voltage substrate: implications for arrhythmia freedom following pulmonary vein isolation. 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. 2020; 22: 240–249.
Lin Y, Yang B, Garcia FC, Ju W, Zhang F, Chen H, et al. Comparison of left atrial electrophysiologic abnormalities during sinus rhythm in patients with different type of atrial fibrillation. Journal of Interventional Cardiac Electrophysiology: an International Journal of Arrhythmias and Pacing. 2014; 39: 57–67.
Vincenti A, Rota M, Spinelli M, Corciulo M, De Ceglia S, Rovaris G, et al. A noninvasive index of atrial remodeling in patients with paroxysmal and persistent atrial fibrillation: a pilot study. Journal of Electrocardiology. 2012; 45: 109–115.
Jadidi A, Müller-Edenborn B, Chen J, Keyl C, Weber R, Allgeier J, et al. The Duration of the Amplified Sinus-P-Wave Identifies Presence of Left Atrial Low Voltage Substrate and Predicts Outcome After Pulmonary Vein Isolation in Patients With Persistent Atrial Fibrillation. JACC. Clinical Electrophysiology. 2018; 4: 531–543.
Chen Q, Mohanty S, Trivedi C, Gianni C, Della Rocca DG, Canpolat U, et al. Association between prolonged P wave duration and left atrial scarring in patients with paroxysmal atrial fibrillation. Journal of Cardiovascular Electrophysiology. 2019; 30: 1811–1818.
Anter E, Josephson ME. Bipolar voltage amplitude: What does it really mean? Heart Rhythm. 2016; 13: 326–327.
