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Updated: Jul 6, 2025
Three-Dimensional Echocardiographic Method for the Visualization and Assessment of Specific Parameters of the Pulmonary Veins
Published on: October 28, 2020
P-Wave Morphology From Common Nonpulmonary Vein Trigger Sites Following Pulmonary Vein and Posterior Wall Isolation
Ivaylo R Tonchev1, David Chieng2, Joshua Hawson1
1Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.
Background:
Non-pulmonary vein (PV) triggers are increasingly targeted during atrial fibrillation (AF) ablation. P-wave morphology (PWM) can be useful because point mapping of AF triggers is challenging. The impact of prior ablation on PWM is yet to be determined.
Objectives:
This study sought to report PWM before and after left atrial (LA) ablation and construct a P-wave algorithm of common non-PV trigger locations.
Methods:
This multicenter, prospective, observational study analyzed the paced PWM of 30 patients with persistent AF undergoing pulmonary vein isolation (PVI) and posterior wall isolation (PWI). Pace mapping was performed at the SVC, crista terminalis, inferior tricuspid annulus, coronary sinus ostium, left septum, left atrial appendage, Ligament of Marshall, and inferoposterior LA. The PWM was reported before PVI, then blinded comparisons were made post-PVI and post-PVI + PWI. A P-wave algorithm was constructed.
Results:
A total of 8,352 paced P waves were prospectively recorded. No significant changes in the PWM were seen post-PVI alone in 2,775 of 2,784 (99.7%) and post-PWI in 2,715 of 2,784 (97.5%). Changes in PWM were predominantly at the IPLA (53 P waves) with a positive P-wave in leads V2 to V6 before biphasic post-PWI, LA appendage (9 P waves), coronary sinus ostium (6 P waves), and ligament of Marshall (3 P waves). A PWM algorithm was created before PVI and accurately predicted the location in 93% post-PVI + PWI.
Conclusions:
Minimal change was observed in PWM post-PV and PWI aside from the IPLA location. A P-wave algorithm created before and applied after PVI + PWI provided an accuracy of 93%. PWM provides a reliable tool to guide the localization of common non-PV trigger sites even after PV and PWI.
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