P-SAECG and atrial remodeling
PWD is an electrophysiological parameter that reflects complete atrial
conduction. Studies11-13 have reported that P-SAECG
findings are closely related to AF recurrence after CA. Okumura et
al.12 performed P-SAECG before and after CA (n=51) in
patients with paroxysmal and persistent AF. Patients with successful CA
had a more significant shortening of the PWD (from 146 ± 13 to 136 ± 12
ms; P <0.01) than those in whom recurrence occurred (from 167 ±
15 to 157 ± 15 ms; P= 0.18). Ogawa et al.11reported a significant reduction in PWD (from 161 ± 7 to 151 ± 8 ms;
ΔPWD 10 ± 7 ms; P <0.0001) after CA in patients with
paroxysmal and persistent AF (n=27), although they observed no
significant shortening in PWD in patients with AF recurrence. Masuda et
al.13 performed P-SAECG before and 1 day after CA
(n=88) in patients with paroxysmal AF. Although there were no
differences in pre-CA P-SAECG findings, AF recurrence was significantly
more common in patients with a long PWD and low RMS20 1
day after CA than those without them (54% vs. 19%, P=0.001). These
reports suggest that improvement in atrial conduction parameters could
be associated with a reduced recurrence rate after CA because ALP is a
marker of abnormal atrial electrical properties such as intra-atrial or
inter-atrial conduction disturbance.
In our study, we evaluated a large number of patients with paroxysmal AF
and focused on the prediction of AF recurrence based on positive ALP
before CA. Consequently, the rate of positive ALP before CA (a long PWD
and a low RMS20) was significantly higher in the
Recurrence group than in the Non-recurrence group. These results suggest
that the parameter of positive ALP on P-SAECG could be used to detect
the electrical remodeling.