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P Wave Duration and Morphology Predict Atrial Fibrillation Recurrence in Patients with Sinus Node Dysfunction and Atrial‐Based Pacemaker
Author(s) -
DE SISTI ANTONIO,
LECLERCQ JEAN FRANÇOIS,
STIUBEI MARCEL,
FIORELLO PIERRE,
HALIMI FRANCK,
ATTUEL PATRICK
Publication year - 2002
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1046/j.1460-9592.2002.01546.x
Subject(s) - medicine , atrial fibrillation , cardiology , sick sinus syndrome , sinus (botany) , artificial cardiac pacemaker , univariate analysis , multivariate analysis , botany , biology , genus
DE SISTI, A., et al. : P Wave Duration and Morphology Predict Atrial Fibrillation Recurrence in Patients with Sinus Node Dysfunction and Atrial‐Based Pacemaker. P wave duration and morphology have never been systematically evaluated as markers of AF in patients with a conventional indication to pacing. This study correlated sinus P wave duration and morphology and the incidence of AF in patients with sinus node dysfunction (SND), previous history of AF before implant, and atrial‐based pacemaker. Included were 140 patients (86 men, 54 women; mean age 71.8 ± 10.4 years) with recurrent paroxysmal AF and who received a DDD (128 patients) or AAI (12 patients) pacemaker for SND. Forty‐nine patients had structural heart disease. Sinus P wave duration and morphology was evaluated in leads II, III. Twenty‐two patients had an abnormal P wave morphology, diphasic (+/‐) in 5 and notched (+/+) in 17. The basic pacemaker rate was programmed between 60 and 70 beats/min. Rate responsive function was activated in 65 patients. During a follow‐up of 27.6 ± 17.8 months, AF was documented in 87 patients. Forty‐four patients developed permanent AF, following at least one episode of paroxysmal AF in 26 cases. Statistical analysis used Cox model regression. Univariate predictors of AF (P < 0.10) were drugs (mean: 2 ± 1.4 ) and DC shock before pacing (16/140 patients), P wave duration (mean 112.5 ± 24.6 ms), basic pacemaker rate (mean 68 ± 5 beats/min), and drugs in the follow‐up (mean 1.2 ± 0.94 ). Multivariate analysis showed that P wave duration ( b = 0.013, s.e. = 0.004; P = 0.003 ), and drugs before pacing ( b = 0.2; s.e.= 0.08; P < 0.01 ) resulted in a significant independent predictor of AF. Actuarial incidence of patients free of AF at 30 months was 35%: 56% in patients with a P wave < 120 ms, and 13% in those with P wave ≥ 120 ms (P < 0.01 by Score test). Univariate predictors of permanent AF were drugs and DC shock before pacing, left atrial size (mean 39 ± 6 mm), P wave duration, abnormal P wave morphology (22/140 patients), and drugs in the follow‐up. Multivariate analysis showed that P wave morphology was the most important predictor of permanent AF ( b = ‐ 0.56, s.e.= 0.2; P = 0.008 ). Incidence of patients free of permanent AF at 30 months was 69%: 74% in patients with normal P wave, compared to 28% in the case of abnormal P wave morphology (P < 0.01). P wave duration and morphology are good markers of postpacing AF recurrence in patients with SND and an atrial‐based pacemaker. This observation suggests that intra‐ and interatrial conduction disturbances be extensively evaluated before implantation, and the indication for atrial resynchronization procedures be reevaluated.