| BackgroundsRadiofrequency catheter ablation(RFCA)of atrial fibrillation(AF)has been widely implemented with promising efficacy and safety.However,long term arrhythmic recurrence following catheter ablation was not uncommon[1].Accurate prediction of ablation outcomes is of great importance concerning optimizing indications,offering reasonable expectations,formulating ablation plans,selecting postoperative anti-arrhythmic and anti-coagulation drugs,arranging postoperative follow-up regimens as well as arrhythmic monitoring devices[2].A variety of ECG parameters have been proved to be able to predict ablation outcome[3,4].However,they are not widely used in clinical practice due to laborious signal processing,lack of standardization and inconsistent predictive results from different studies.Objectives1.Investigating the characteristics and changes of P wave parameters before and after RFCA in patients with AF and their correlation with arrhythmia recurrence2.Investigating the characteristics of f wave parameters before RFCA and their correlation with arrhythmia recurrenceMethodsThe first part of the study prospectively enrolled patients with AF underwent RFCA from October 2018 to October 2019 in the department of cardiology of Peking Union Medical College Hospital.Baseline clinical data,preoperative and postoperative 12 lead ECG were collected.Original ECG signals were amplified for measurement of P wave parameters.Differences of clinical and ECG parameters with respect to different AF type and prognosis were thoroughly studied.The association between clinical and ECG parameters and recurrence of arrhythmia was evaluated.The second part of the study retrospectively included patients with AF for RFCA in our center from April 2016 to December 2017 and from September 2018 to October 2019.All cases underwent AF rhythm before procedure.Baseline clinical data and 12-lead ECG were obtained before procedure.Atrial signals were extracted for Fourier transformation to calculate dominant frequency(DF)and organized index(OI).Differences of clinical and ECG parameters regarding patients with different type of AF and prognosis were investigated.Results1.Compared with that of paroxysmal AF(PxAF),postoperative P wave duration(PWD)of lead II(P<0.001),lead V1(P<0.001)and the maximum P wave duration(PWDmax)of 12 leads(P=0.001)were significantly prolonged in patients with persistent AF(PeAF),with significantly increased lead V1 P wave amplitude(PWA)and Vector magnitude(VM).2.Compared with non-recurrent patients,patients with recurrence had significantly longer postoperative PWD in lead II(152.10(146.30-157.92)ms vs 145.00(134.05-159.49)ms;P=0.019).Postoperative lead Ⅱ PWD was significantly associated with long term recurrence(HR 2.534,95%CI 1.137-5.647;P=0.023).Taken lead Ⅱ PWD>148ms as cutoff point,the sensitivity and specificity for long term recurrence discrimination were 66.7%and 58.2%respectively.The area under the receiver operating curve(ROC)was 0.624.(95%CI 0.506-0.742:P=0.049).3.Preoperative mean DF(DFmean)was significantly higher in patients with PeAF than that of patients with PxAF(6.16±0.75Hz vs 5.52±0.75Hz;P=0.001).4.There was a significant negative correlation between DF and OI(r=-0.379;P<0.001).However,correlation between f wave parameters and recurrence was not significant statistically.Conclusion1.Significant differences existed in postoperative P wave parameters regarding patients with different AF type and prognosis.Prolonged postoperative lead Ⅱ PWD was significantly correlated with long term recurrence.2.Preoperative DF was significantly higher in patients with PeAF than that of patients with PxAF and negatively correlated with OI,which may suggest increased complexity of electrical activity.3.The association between the f wave parameters and recurrence was not significant in this study. |
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