1
|
Koutalas E, Intzes S, Zagoridis K, Symeonidou M, Spanoudakis E, Arya A, Dinov B, Dagres N, Hindricks G, Bollmann A, Kanoupakis E, Kochiadakis G, Nedios S. P-wave duration and atrial fibrillation recurrence after catheter ablation, a systematic review and meta-analysis. Europace 2022. [DOI: 10.1093/europace/euac053.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Atrial fibrillation (AF) is a global health problem with high morbidity and mortality. Catheter ablation (CA) can reduce AF burden and symptoms, but AF recurrence (AFr) remains an issue. Simple AFr predictors like P-wave duration (PWD) could help improve AF therapy.
Purpose
This updated meta-analysis reviews the increasing evidence for the association of AFr with PWD and offers practical implications.
Methods
Publication databases were systematically searched and cohort studies reporting PWD and/or morphology at baseline and AFr after CA were included. Complete interatrial block (cIAB) was defined as PWD≥120 ms and biphasic morphology in inferior leads. Random-effects analysis was performed using the Review Manager 5.3 and R programs after study selection, quality assessment and data extraction, to report odds ratio (OR) and confidence intervals (CI).
Results
Among 4175 patients in 22 studies, 1138 (27%) experienced AFr. Patients with AFr had longer PWD with a mean pooled difference of 7.8 ms (19 studies, p<0.001)(Figure 1). Pooled OR was 2.04 (1.16-3.58) for PWD>120 ms (13 studies, p=0.01), 2.42 (1.12-5.21) for PWD>140 ms (2 studies, p=0.02), 3.97 (1.79-8.85) for cIAB (6 studies, p<0.001) and 10.89 (4.53-26.15) for PWD>150 ms (2 studies, p<0.001)(Figure 2). There was significant heterogeneity but no publication bias detected.
Conclusion
PWD is an independent predictor for AF recurrence after LA ablation. The AFr risk is increasing exponentially with PWD prolongation. This could facilitate risk-stratification by identifying high-risk patients (cIAB, PWD>150 ms) and adjusting follow-up or interventions.
Collapse
Affiliation(s)
- E Koutalas
- University Hospital of Heraklion, Heraklion, Greece
| | - S Intzes
- Democritus University of Thrace, Medical School, Alexandroupolis, Greece
| | - K Zagoridis
- Democritus University of Thrace, Medical School, Alexandroupolis, Greece
| | - M Symeonidou
- Democritus University of Thrace, Medical School, Alexandroupolis, Greece
| | - E Spanoudakis
- Democritus University of Thrace, Medical School, Alexandroupolis, Greece
| | - A Arya
- Heart Center of Leipzig, Department of Electrophysiology, Leipzig, Germany
| | - B Dinov
- Heart Center of Leipzig, Department of Electrophysiology, Leipzig, Germany
| | - N Dagres
- Heart Center of Leipzig, Department of Electrophysiology, Leipzig, Germany
| | - G Hindricks
- Heart Center of Leipzig, Department of Electrophysiology, Leipzig, Germany
| | - A Bollmann
- Heart Center of Leipzig, Department of Electrophysiology, Leipzig, Germany
| | - E Kanoupakis
- University Hospital of Heraklion, Heraklion, Greece
| | | | - S Nedios
- Heart Center of Leipzig, Department of Electrophysiology, Leipzig, Germany
| |
Collapse
|