Dynamic changes in signal-averaged P wave after catheter ablation of atrial fibrillation

Dony Yugo, Ming Jen Kuo, Yu Feng Hu*, Chih Min Liu, Yenn Jiang Lin, Shih Lin Chang, Li Wei Lo, Tze Fan Chao, Fa Po Chung, Jo Nan Liao, Ting Yung Chang, Chin Yu Lin, Ta Chuan Tuan, Ling Kuo, Shin Huei Liu, An Nu Khanh Ton, Chheng Chhay, Ahmed Elimam, Shih Ann Chen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: The comprehensive surveillance for interval changes in signal-averaged P-wave (SAPW) after pulmonary vein isolation (PVI) remains lacking. We aimed to analyze the SAPW parameters before and after PVI and explored their link to the left atrial electrical properties. Methods: Eighteen patients with paroxysmal atrial fibrillation receiving primary catheter ablation were enrolled. SAPW parameters, including root mean square voltages in the last 40, 30, and 20 ms (RMS40, RMS30, and RMS20, respectively), the total P-wave (RMSt), the integral of P-wave potentials (Int-p), and P-wave duration (fPWD), were measured before and after PVI and correlated to the left atrial activation time (LAT) and mean left atrial voltage (LAV) from electro-anatomical mapping. Results: Compared with the SAPW before PVI, fPWD (before vs after PVI: 144.1 ± 5.2 vs 135.1 ± 11.9 ms, p = 0.02), Int-p (687.4 ± 173.1 vs 559 ± 202.5 mVms, p = 0.01), and RMSt (6.44 ± 1.3 vs 5.44 ± 2.0 mV, p = 0.04) all decreased after PVI. RMS20, RMS30, and RMS40 showed no significant difference. Similarly, LAT (97.5 ± 9.3 vs 90.5 ± 9.3 ms, p = 0.008) and LAV (1.37 ± 0.27 vs 0.96 ± 0.31 mV, p = 0.001) decreased after PVI. Although consistent changes after PVI were observed between SAPW parameters and LAT or LAV, no linear correlation was observed among them. Conclusion: The consistent changes in SAPW and left atrial electrical properties after PVI suggest that SAPW may be used as a noninvasive tool to monitor the responses to PVI.

Original languageEnglish
Pages (from-to)549-553
Number of pages5
JournalJournal of the Chinese Medical Association
Issue number5
StatePublished - 1 May 2022


  • Atrial fibrillation
  • Left atrial activation time
  • Pulmonary vein isolation
  • Signal-averaged ECG


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