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.

摘要

Background: Identification of patients at risk for PAF recurrence after AP ablation is important because of the necessity for additional therapies. Objectives: To determine whether Maximum P-wave duration ( P (max)) and P-wave dispersion ( Pd ) detected on surface ECG after successful accessory pathway (AP) ablation can predict the recurrence of paroxysmal atrial fibrillation (PAF). Methods: Seventy-eight patients with Wolff-Parkinson-White (WPW) syndrome who had at least one documented PAF episode and underwent catheter ablation were enrolled. P(max), minimum P-wave duration ( P (min)) and Pd were determined on a surface ECG recorded on a high resolution computer screen on day 2 after ablation of the AP. Results: There was no significant difference in terms of basic clinical data and electrophysiological findings between patients with (Group-1, n = 19) and without (Group-2, n = 59) recurrence of PAF during follow-up of 21 +/- 10 months. P (max) and Pd were significantly higher in Group-1 than Group-2 (120 +/- 15 vs. 96 +/- 10 ms and 47 +/- 12 vs. 25 +/- 7 ms, respectively; p < 0.001 for both). P (min) didn't differ significantly. A P (max) value of >/= 103 ms separated Group-1 from Group-2 with a sensitivity of 84.2%, specificity of 72.9%, positive predictive value of 50%, and negative predictive value of 93.5%. A Pd value of >/= 32.5 ms separated Group-1 from Group-2 with a sensitivity of 89.5%, specificity of 84.7%, positive predictive value of 65.4%, and negative predictive value of 96.2%. P (max) ( p < 0.010) and Pd ( p < 0.001) were found to be significant univariate predictors of PAF, whereas only Pd remained significant in multivariate analysis ( p = 0.037). Conclusion: Pd >/= 32.5 ms and P (max) >/= 103.0 ms predict the recurrence of PAF after ablation with acceptable positive and negative predictive values. Pd >/= 32.5 ms is an independent predictor of recurrence of PAF after catheter ablation in patients with WPW syndrome.