Arrhythmias & electrophysiology
P-Wave Morphology From Common Nonpulmonary Vein Trigger Sites Following Pulmonary Vein and Posterior Wall Isolation
Authors' conclusion
Minimal change was observed in PWM post-PV and PWI aside from the IPLA location. A P-wave algorithm created before and applied after PVI + PWI provided an accuracy of 93%.
Study context
- Population
- Patients with persistent atrial fibrillation (AF) undergoing pulmonary vein isolation (PVI) and posterior wall isolation (PWI); pace mapping at common non-PV trigger sites8,352 paced P waves
- Participants
- 30 patients
- Exposure
- Paced P-wave morphology before vs after PVI and PVI + PWI
- Outcome
- No significant change in PWM
Methodological detailsmulticentre, blinded comparisons
- Multicentre
- Blinded comparisons
Main finding
As reported in the abstract
Post-PVI
99.7%
2,775 events
Post-PVI + PWI
97.5%
2,715 events
Observational data: associations, not effects.
Further findings
Sites of P-wave morphology (PWM) change post-PWI
- IPLA (positive in V2–V6 before, biphasic post-PWI), P waves
- 53
- Left atrial (LA) appendage, P waves
- 9
- Coronary sinus ostium, P waves
- 6
- Ligament of Marshall, P waves
- 3
Accuracy of pre-PVI PWM algorithm post-PVI + PWI
- Location correctly predicted
- 93%
Original publication
P-Wave Morphology From Common Nonpulmonary Vein Trigger Sites Following Pulmonary Vein and Posterior Wall Isolation. JACC Clin Electrophysiol. Published 3 January 2024. doi:10.
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