Prediction of AF recurrence after CA using P-SAECG
Structural and electrical remodeling have been reported as the causes of arrhythmias.14 Findings suggestive of dilatation on non-invasive modalities such as echocardiography or computed tomography could indicate structural remodeling of the atrium. Preoperative left atrial diameter (LAD) has been reported to be associated with AF recurrence after CA.15,16 Structural remodeling in the form of LA enlargement is the most common arrhythmogenic substrate. P-wave duration on surface 12-lead ECG has also been associated with AF recurrence after CA.17,18 A long P-wave duration is associated with an enlarged LA19 and atrial conduction disturbance.20 We demonstrated that positive ALP was an independent predictor of AF recurrence after CA, and there were no significant differences in the LAD and P-wave duration on surface 12-lead ECG between the Recurrence and Non-Recurrence groups. This may be because our study population only consisted of patients with paroxysmal AF who had a short disease duration and in whom structural remodeling might not have progressed. ALP could reflect subtle changes in the atria that are not structural changes and do show up as changes in the P-wave on 12-lead ECG. Based on the results of our study, we speculate that ALP can reveal the progression of electrical remodeling in patients without structural remodeling.