Value of P‐wave Parameters in Predicting Outcomes of Repeat Catheter Ablation for Paroxysmal Atrial Fibrillation

ABSTRACT Background Pulmonary vein isolation (PVI) has been established as an effective management option for symptomatic paroxysmal atrial fibrillation (PAF). We aimed to explore the role of P‐wave parameters in a 12‐lead electrocardiogram (ECG) in predicting the success of repeat PAF ablation. Methods We enrolled consecutive patients who underwent a second AF ablation procedure for PAF in a UK tertiary center after an index ablation conducted between 2018 and 2019 and a repeat ablation up to 2021. A digital 12‐lead ECG was recorded with a 1–50‐Hz bandpass filter applied. P‐wave duration (PWD), P‐wave voltage (PWV), P‐wave dispersion (PWDisp), and P‐wave terminal force in V1 (PTFV1) were measured before and after the procedure. Changes were correlated with the 12‐month clinical outcome. Procedural success was freedom from ECG‐documented AF up to 12 months following ablation. Results Study criteria were satisfied by 72 patients, of which 43 (60%) had successful repeat PVI at 12 months. The mean age is 65, and 47 (65%) were males. The demographics were comparable between both study arms. PWD decreased after successful repeat ablations (136.7 to 124.6 ms, p = 0.01) and failed repeat ablations (135.4 to 125.3 ms, p = 0.009) without a significant change between both arms. PMV and PWDisp did not change significantly after both study arms. PTFV1 significantly decreased after successful repeat ablations (‐3.1 to ‐4.4 mm.s, p = 0.005) without a significant change after failed ablations (‐2.9 to ‐2.7 mm.s, p = 0.42). Changes were statistically significant between both arms (p = 0.004). Conclusion PTFV1 reduction following the second AF ablation was correlated with successful repeat AF ablation at 12 months.