Impact of catheter ablation on P-wave parameters on 12-lead electrocardiogram in patients with atrial fibrillation

Background Catheter ablation has emerged as a widely used treatment modality for atrial fibrillation (AF). P-wave abnormalities have been described in the patients with AF, and catheter ablation may potentially further impact P-wave parameters due to ablation of atrial tissue. Methods We reviewed data on P-wave parameters (P-wave duration, amplitude and P-wave duration and amplitude product) in leads V1 and aVF and changes in the P-terminal force (Ptf; product of duration and amplitude of terminal part of P-wave) in lead V1 from 12-lead electrocardiograms obtained prior to and after CA of a total of 46 (28 paroxysmal and 18 persistent) AF patients. Results The median age of patients in our study was 63 (range: 30-77) years. We noticed a significant reduction in the P-wave duration (from 87.39 ± 28.62 ms at baseline to 72.09 ± 24.59 ms; p = 0.0072) and the product of P-wave duration and amplitude in lead V1 (12.16 ± 5.54 mV ms at baseline to 8.30 ± 5.78 mV ms, p = 0.0015) after CA. There was also a significant decrease in P-wave duration (from 92.57 ± 19.67 ms at baseline to 76.48 ± 16.32 ms after CA, p = 0.0001) and P-wave duration and amplitude product in lead aVF (12.61 ± 4.05 mV ms at baseline to 9.77 ± 3.86 m V ms after CA, p = 0.0001). CA also led to a significant decrease in Ptf (from 4.56 ± 1.88 at baseline to 2.85 ± 1.42 mV ms, p < 0.0001). Conclusion Radiofrequency catheter ablation of AF leads to modification of P-wave parameters with substantial diminution in both the amplitude and duration of the P-wave in leads V1 and aVF. This likely represents reduction in electrically active atrial tissue after ablation, and may serve as a marker for the extent of ablated atrial tissue.