Changes in P-wave morphology after pulmonary vein isolation: insights from computer simulations

Mirabeau Saha; Giulio Conte; Maria Luce Caputo; François Regoli; Rolf Krause; Angelo Auricchio; Vincent Jacquemet

doi:10.1093/europace/euw348

Changes in P-wave morphology after pulmonary vein isolation: insights from computer simulations

Mirabeau Saha, Giulio Conte, Maria Luce Caputo, François Regoli, Rolf Krause, Angelo Auricchio, Vincent Jacquemet

Applied Mathematics and Computational Science

Research output: Contribution to journal › Article › peer-review

8 Scopus citations

Abstract

AIMS: Apparently conflicting clinical measurements of P-wave duration (PWD) pre- vs. post-ablation have been reported. To assist the interpretation of these clinical data, we used a computer model of the atria and torso to simulate P waves before and after pulmonary vein (PV) isolation.

METHODS AND RESULTS: Twenty ablation patterns were designed (segmental or ipsilateral ablation; five distances to PV sleeves; addition of a roof line or not). Possible PV reconnections were introduced as gaps in the ablation lines. PWD and area were measured during sinus rhythm in vectorcardiogram (VCG) magnitude signals and on the 16-lead ECG before and after ablation, and after PV reconnection. After PV isolation, biatrial activation time was prolonged by 0-5 ms without and by 48±5 ms with roof line. Yet PWD was shortened in lead V3 and V4 by up to 15 ms. The effect of ablation on P-wave morphology was stronger when larger PV areas were isolated. Segmental and ipsilateral PV isolation led to concordant results. P-wave area increased in V1 and decreased in V6. Changes in PWD and area on the VCG were sensitive to the threshold used for detecting the end of the P wave. The occurrence of PV reconnection was best identified on leads V3, V4, and V9.

CONCLUSION: PV isolation and reconnection induced measurable changes on the 16-lead ECG that might be used to improve patient follow-up after ablation.

Original language	English (US)
Pages (from-to)	iv23-iv34
Journal	Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
Volume	18
DOIs	https://doi.org/10.1093/europace/euw348
State	Published - Dec 1 2016

Bibliographical note

Publisher Copyright:
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For Permissions, please email: [email protected].

Keywords

Activation map
Atrial fibrillation
Catheter ablation
Computer modelling
P-wave morphology
Pulmonary vein reconnection

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Physiology (medical)

Access to Document

10.1093/europace/euw348

Cite this

Saha, M., Conte, G., Caputo, M. L., Regoli, F., Krause, R., Auricchio, A., & Jacquemet, V. (2016). Changes in P-wave morphology after pulmonary vein isolation: insights from computer simulations. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 18, iv23-iv34. https://doi.org/10.1093/europace/euw348

Saha, Mirabeau ; Conte, Giulio ; Caputo, Maria Luce et al. / Changes in P-wave morphology after pulmonary vein isolation : insights from computer simulations. In: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2016 ; Vol. 18. pp. iv23-iv34.

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abstract = "AIMS: Apparently conflicting clinical measurements of P-wave duration (PWD) pre- vs. post-ablation have been reported. To assist the interpretation of these clinical data, we used a computer model of the atria and torso to simulate P waves before and after pulmonary vein (PV) isolation.METHODS AND RESULTS: Twenty ablation patterns were designed (segmental or ipsilateral ablation; five distances to PV sleeves; addition of a roof line or not). Possible PV reconnections were introduced as gaps in the ablation lines. PWD and area were measured during sinus rhythm in vectorcardiogram (VCG) magnitude signals and on the 16-lead ECG before and after ablation, and after PV reconnection. After PV isolation, biatrial activation time was prolonged by 0-5 ms without and by 48±5 ms with roof line. Yet PWD was shortened in lead V3 and V4 by up to 15 ms. The effect of ablation on P-wave morphology was stronger when larger PV areas were isolated. Segmental and ipsilateral PV isolation led to concordant results. P-wave area increased in V1 and decreased in V6. Changes in PWD and area on the VCG were sensitive to the threshold used for detecting the end of the P wave. The occurrence of PV reconnection was best identified on leads V3, V4, and V9.CONCLUSION: PV isolation and reconnection induced measurable changes on the 16-lead ECG that might be used to improve patient follow-up after ablation.",

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Saha, M, Conte, G, Caputo, ML, Regoli, F, Krause, R, Auricchio, A & Jacquemet, V 2016, 'Changes in P-wave morphology after pulmonary vein isolation: insights from computer simulations', Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, vol. 18, pp. iv23-iv34. https://doi.org/10.1093/europace/euw348

Changes in P-wave morphology after pulmonary vein isolation: insights from computer simulations. / Saha, Mirabeau; Conte, Giulio; Caputo, Maria Luce et al.
In: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Vol. 18, 01.12.2016, p. iv23-iv34.

Research output: Contribution to journal › Article › peer-review

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T1 - Changes in P-wave morphology after pulmonary vein isolation

T2 - insights from computer simulations

AU - Saha, Mirabeau

AU - Conte, Giulio

AU - Caputo, Maria Luce

AU - Regoli, François

AU - Krause, Rolf

AU - Auricchio, Angelo

AU - Jacquemet, Vincent

PY - 2016/12/1

Y1 - 2016/12/1

N2 - AIMS: Apparently conflicting clinical measurements of P-wave duration (PWD) pre- vs. post-ablation have been reported. To assist the interpretation of these clinical data, we used a computer model of the atria and torso to simulate P waves before and after pulmonary vein (PV) isolation.METHODS AND RESULTS: Twenty ablation patterns were designed (segmental or ipsilateral ablation; five distances to PV sleeves; addition of a roof line or not). Possible PV reconnections were introduced as gaps in the ablation lines. PWD and area were measured during sinus rhythm in vectorcardiogram (VCG) magnitude signals and on the 16-lead ECG before and after ablation, and after PV reconnection. After PV isolation, biatrial activation time was prolonged by 0-5 ms without and by 48±5 ms with roof line. Yet PWD was shortened in lead V3 and V4 by up to 15 ms. The effect of ablation on P-wave morphology was stronger when larger PV areas were isolated. Segmental and ipsilateral PV isolation led to concordant results. P-wave area increased in V1 and decreased in V6. Changes in PWD and area on the VCG were sensitive to the threshold used for detecting the end of the P wave. The occurrence of PV reconnection was best identified on leads V3, V4, and V9.CONCLUSION: PV isolation and reconnection induced measurable changes on the 16-lead ECG that might be used to improve patient follow-up after ablation.

AB - AIMS: Apparently conflicting clinical measurements of P-wave duration (PWD) pre- vs. post-ablation have been reported. To assist the interpretation of these clinical data, we used a computer model of the atria and torso to simulate P waves before and after pulmonary vein (PV) isolation.METHODS AND RESULTS: Twenty ablation patterns were designed (segmental or ipsilateral ablation; five distances to PV sleeves; addition of a roof line or not). Possible PV reconnections were introduced as gaps in the ablation lines. PWD and area were measured during sinus rhythm in vectorcardiogram (VCG) magnitude signals and on the 16-lead ECG before and after ablation, and after PV reconnection. After PV isolation, biatrial activation time was prolonged by 0-5 ms without and by 48±5 ms with roof line. Yet PWD was shortened in lead V3 and V4 by up to 15 ms. The effect of ablation on P-wave morphology was stronger when larger PV areas were isolated. Segmental and ipsilateral PV isolation led to concordant results. P-wave area increased in V1 and decreased in V6. Changes in PWD and area on the VCG were sensitive to the threshold used for detecting the end of the P wave. The occurrence of PV reconnection was best identified on leads V3, V4, and V9.CONCLUSION: PV isolation and reconnection induced measurable changes on the 16-lead ECG that might be used to improve patient follow-up after ablation.

KW - Activation map

KW - Atrial fibrillation

KW - Catheter ablation

KW - Computer modelling

KW - P-wave morphology

KW - Pulmonary vein reconnection

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Saha M, Conte G, Caputo ML, Regoli F, Krause R, Auricchio A et al. Changes in P-wave morphology after pulmonary vein isolation: insights from computer simulations. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2016 Dec 1;18:iv23-iv34. doi: 10.1093/europace/euw348

Changes in P-wave morphology after pulmonary vein isolation: insights from computer simulations

Abstract

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Keywords

ASJC Scopus subject areas

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