Prolonged P-wave duration in sinus rhythm pre-ablation is associated with atrial fibrillation recurrence after pulmonary vein isolation-A systematic review and meta-analysis

Introduction A prolonged P-wave duration (PWD) in sinus rhythm pre-ablation has been hypothesized to be a non-invasive ECG marker associated with increased atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). This systematic review and meta-analysis will assess the latest evidence on the association of prolonged PWD pre-ablation with AF recurrence after PVI. Hypothesis Prolonged PWD pre-ablation is associated with AF recurrence after PVI. Methods The inclusion criteria for this study are all cohort studies that assess prolonged PWD on ECG during sinus rhythm pre-ablation and its association with AF recurrence in post-PVI patients. Results There were 1,482 patients with AF post-PVI from twelve cohort studies. The cut-off points for prolonged PWD ranges from >120 ms to >150 ms. Meta-analysis on six studies showed a pooled mean difference of PWD in subjects with recurrent AF and non-recurring AF was 12.54 ms [8.76-16.31], p I-2 78%. Pooled odds ratio was 4.17 [2.10-8.31], p I-2 72% and pooled hazard ratio was 1.93 [1.10-3.39], p = 0.02; I-2 80%. Upon subgroup analysis, the association between prolonged PWD and AF recurrence was significant in signal-averaged ECG, 12-lead ECG, paroxysmal AF, >120-130 ms, and >140-150 ms PWD cut-off point subgroups. Conclusion These findings suggest that prolonged PWD with a cutoff of >120 ms to >150 ms in sinus rhythm before ablation may be associated with AF recurrence after PVI regardless of age, gender, left atrial size, and the presence of structural heart disease. We also encouraged further studies that investigate predicting models to include prolonged PWD as one of their parameters.