Reduction in atrial and ventricular electrical heterogeneity following pulmonary vein isolation in patients with atrial fibrillation

Guilherme L Fialho; Bruce D Nearing; Jonathan W Waks; Timothy R Maher; John-Ross Clarke; Alyssa Shepherd; Andre D'Avila; Richard L Verrier

doi:10.1007/s10840-023-01543-7

Reduction in atrial and ventricular electrical heterogeneity following pulmonary vein isolation in patients with atrial fibrillation

J Interv Card Electrophysiol. 2023 Apr 19. doi: 10.1007/s10840-023-01543-7. Online ahead of print.

Authors

Guilherme L Fialho^{1

2}, Bruce D Nearing², Jonathan W Waks², Timothy R Maher², John-Ross Clarke², Alyssa Shepherd², Andre D'Avila², Richard L Verrier³

Affiliations

¹ Federal University of Santa Catarina, Florianopolis, Brazil.
² Departments of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
³ Departments of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA. rverrier@bidmc.harvard.edu.

PMID: 37074510
DOI: 10.1007/s10840-023-01543-7

Abstract

Background: Pulmonary vein isolation (PVI) modulates the intrinsic cardiac autonomic nervous system and reduces atrial fibrillation (AF) recurrence.

Methods: In this retrospective analysis, we investigated the impact of PVI on ECG interlead P-wave, R-wave, and T-wave heterogeneity (PWH, RWH, TWH) in 45 patients in sinus rhythm undergoing clinically indicated PVI for AF. We measured PWH as a marker of atrial electrical dispersion and AF susceptibility and RWH and TWH as markers of ventricular arrhythmia risk along with standard ECG measures.

Results: PVI acutely (16 ± 8.9 h) reduced PWH by 20.7% (from 31 ± 1.9 to 25 ± 1.6 µV, p < 0.001) and TWH by 27% (from 111 ± 7.8 to 81 ± 6.5 µV, p < 0.001). RWH was unchanged after PVI (p = 0.068). In a subgroup of 20 patients with longer follow-up (mean = 47 ± 3.7 days after PVI), PWH remained low (25 ± 1.7 µV, p = 0.01), but TWH partially returned to the pre-ablation level (to 93 ± 10.2, p = 0.16). In three individuals with early recurrence of atrial arrhythmia in the first 3 months after ablation, PWH increased acutely by 8.5%, while in patients without early recurrence, PWH decreased acutely by 22.3% (p = 0.048). PWH was superior to other contemporary P-wave metrics including P-wave axis, dispersion, and duration in predicting early AF recurrence.

Conclusion: The rapid time course of decreased PWH and TWH after PVI suggests a beneficial influence likely mediated via ablation of the intrinsic cardiac nervous system. Acute responses of PWH and TWH to PVI suggest a favorable dual effect on atrial and ventricular electrical stability and could be used to track individual patients' electrical heterogeneity profile.

Keywords: Ablation; Atrial fibrillation recurrence; Electrical dispersion; P-wave heterogeneity; Pulmonary vein isolation; T-wave heterogeneity.