Amplified sinus-P-wave analysis predicts outcomes of cryoballoon ablation in patients with persistent and long-standing persistent atrial fibrillation: A multicentre study.

Introduction: Outcomes of catheter ablation for non-paroxysmal atrial fibrillation (AF) remain suboptimal. Non-invasive stratification of patients based on the presence of atrial cardiomyopathy (ACM) could allow to identify the best responders to pulmonary vein isolation (PVI).
Methods: Observational multicentre retrospective study in patients undergoing cryoballoon-PVI for non-paroxysmal AF. The duration of amplified P-wave (APW) was measured from a digitally recorded 12-lead electrocardiogram during the procedure. If patients were in AF, direct-current cardioversion was performed to allow APW measurement in sinus rhythm. An APW cut-off of 150 ms was used to identify patients with significant ACM. We assessed freedom from arrhythmia recurrence at long-term follow-up in patients with APW ≥ 150 ms vs. APW < 150 ms.
Results: We included 295 patients (mean age 62.3 ± 10.6), of whom 193 (65.4%) suffered from persistent AF and the remaining 102 (34.6%) from long-standing persistent AF. One-hundred-forty-two patients (50.2%) experienced arrhythmia recurrence during a mean follow-up of 793 ± 604 days. Patients with APW ≥ 150 ms had a significantly higher recurrence rate post ablation compared to those with APW < 150 ms (57.0% vs. 41.6%; log-rank p  < 0.001). On a multivariable Cox-regression analysis, APW≥150 ms was the only independent predictor of arrhythmia recurrence post ablation (HR 2.03 CI _95% 1.28-3.21; p  = 0.002).
Conclusion: APW duration predicts arrhythmia recurrence post cryoballoon-PVI in persistent and long-standing persistent AF. An APW cut-off of 150 ms allows to identify patients with significant ACM who have worse outcomes post PVI. Analysis of APW represents an easy, non-invasive and highly reproducible diagnostic tool which allows to identify patients who are the most likely to benefit from PVI-only approach.
Competing Interests: SB is a consultant for Medtronic and Boston Scientific. AC has received an educational grant from Abbott and consultant fees from Boston Scientific. RJS has received research grants and speaker fees from Abbott, Medtronic, Boston Scientific, Johnson and Johnson and is a shareholder of AI Rhythm. MF has received research support from Abbott; Chief Medical Officer, Founder and Shareholder of Echopoint Medical Ltd; Director, Founder and Shareholder of Rhythm AI and Founder and Shareholder of Epicardio Ltd. RJH is founder and shareholder of Rhythm AI Ltd. PDL has received educational grants from Medtronic and Boston Scientific, and is supported by UCLH Biomedicine NIHR and Barts BRC funding. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(© 2023 Creta, Venier, Tampakis, Providencia, Sunny, Defaye, Earley, Finlay, Hunter, Lambiase, Papageorgiou, Schilling, Sporton, Andrikopoulos, Deschamps, Albenque, Cardin, Combes, Combes, Vinolas, Moreno-Weidmann, Huang, Eichenlaub, Müller-Edenborn, Arentz, Jadidi and Boveda.)