• Yan Huo, Fredrik Holmqvist, Jonas Carlson, Thomas Gaspar, Gerhard Hindricks, Christopher Piorkowski, Andreas Bollmann, and Pyotr G Platonov.
• Department of Cardiology and Center for Integrative Electrocardiology at Lund University (CIEL), Lund University, Lund, Sweden; Department of Electrophysiology, Heart Center-University Dresden, Dresden, Germany. Electronic address: dr.huoyan@googlemail.com.
• J Electrocardiol. 2015 Mar 1; 48 (2): 218-25.

IntroductionSevere atrial structural remodeling may reflect irreversible damage of the atrial tissue in patients with atrial fibrillation (AF) and is associated with changes of P-wave duration and morphology. Our aim was to study whether variability of P-wave morphology (PMV) is associated with outcome in patients with AF after circumferential PV isolation (CPVI).Methods And Results70 consecutive patients (aged 60±9years, 46 men) undergoing CPVI due to symptomatic AF were studied. After cessation of antiarrhythmic therapy, standard 12-lead ECG during sinus rhythm was recorded for 10min at baseline and transformed to orthogonal leads. Beat-to-beat P-wave morphology was subsequently defined using a pre-defined classification algorithm. The most commonly observed P-wave morphology in a patient was defined as the dominant morphology. PMV was defined as the percentage of P waves with non-dominant morphology in the 10-min sample. At the end of follow-up, 53 of 70 patients had no arrhythmia recurrence. PMV was greater in patients without recurrence (19.5±17.1% vs. 8.2±6.7%, p<0.001). In the multivariate logistic regression model, PMV≥20% (upper tertile) was the only independent predictor of ablation success (OR=11.4, 95% CI 1.4-92.1, p=0.023). A PMV≥20% demonstrated a sensitivity of 41.5%, a specificity of 94.1%, a PPV of 96.7%, and an NPV of 34.0% for free of AF after CPVI.ConclusionsWe report a significant association between increased PMV and 6-month CPVI success. PMV may help to identify patients with very high likelihood of freedom of AF 6-months after CPVI.Copyright © 2015 Elsevier Inc. All rights reserved.

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