The Effect of Medication on P-wave Beat-to-Beat Variability in Atrial Fibrillation during Sinus Rhythm

Area of Science:

• Cardiology
• Biomedical Engineering
• Medical Signal Processing

Background:

• Atrial Fibrillation (AF) is a common arrhythmia linked to atrial remodeling, altering P-wave morphology (PWM) on ECGs.
• In paroxysmal AF (pAF), PWM changes can be transient, making beat-to-beat analysis crucial for detection.
• Previous research indicates distinct PWM characteristics can differentiate pAF patients from healthy individuals.

Purpose of the Study:

• To investigate the impact of anti-arrhythmic medication on beat-to-beat PWM alternations in pAF patients.
• To explore the potential of ECG signal analysis for non-invasive characterization of low-burden pAF.
• To assess if medication influences the dynamic changes in P-wave morphology during sinus rhythm.

Main Methods:

• Collected high-frequency ECG signals (1000Hz) from three orthogonal leads for pAF patients and healthy volunteers.
• Analyzed beat-to-beat P-wave morphology alternations in patients with minimal/mild AF burden, including those on anti-arrhythmic treatment.
• Employed Kruskal-Wallis test for group comparisons and a 3-class Random Forest classifier for performance evaluation.

Main Results:

• Statistically significant differences were observed between the studied groups (pAF patients with/without medication vs. healthy controls).
• The Random Forest classifier achieved high classification performance with an AUC of 85.75%.
• Preliminary findings suggest medication influences PWM variability in pAF patients.

Conclusions:

• The study provides evidence that anti-arrhythmic medication affects beat-to-beat PWM variability in pAF.
• The developed methodology offers a non-invasive approach for characterizing low-burden pAF patients using ECG.
• Further understanding of medication effects on P-wave dynamics can improve AF management.