Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

P-wave indices predict efficacy outcomes in long-term flecainide treated patients with atrial fibrillation

Siotis, Alexander LU orcid ; Johansson, Samuel ; Graff, Claus ; Madsen Härdig, Bjarne LU and Platonov, Pyotr LU (2024) In Journal of Electrocardiology 85. p.1-22
Abstract
Background/introduction
Flecainide is a commonly used efficient antiarrhythmic drug against atrial fibrillation (AF). P-wave indices reflect the atrial substrate and can predict incident AF, but their role as predictors of treatment outcomes for flecainide-treated AF patients are unknown.

Purpose
To assess if P-wave indices can predict efficacy outcomes in long-term flecainide treated AF patients.

Methods
Consecutive patients admitted for in-hospital flecainide initiation over a 5-year period were retrospectively included. Patient characteristics and baseline ECGs were collected (processed by the 12SL algorithm or manually measured). Echocardiographic measurements were collected up to 1.5 years before... (More)
Background/introduction
Flecainide is a commonly used efficient antiarrhythmic drug against atrial fibrillation (AF). P-wave indices reflect the atrial substrate and can predict incident AF, but their role as predictors of treatment outcomes for flecainide-treated AF patients are unknown.

Purpose
To assess if P-wave indices can predict efficacy outcomes in long-term flecainide treated AF patients.

Methods
Consecutive patients admitted for in-hospital flecainide initiation over a 5-year period were retrospectively included. Patient characteristics and baseline ECGs were collected (processed by the 12SL algorithm or manually measured). Echocardiographic measurements were collected up to 1.5 years before baseline. The study outcome was discontinuation of therapy due inadequate rhythm control (IRC). Cox regression analysis was adjusted for age, sex and left atrial volume index (LAVI).

Results
Sixty-seven patients in sinus rhythm were included and followed up for a median of 1.5 years (mean age 59 ± 13 years, 36% females, AF history duration median of 3.0 years, 56% had ≤34 ml left atrial volume index (LAVI) and 9% had a history of persistent AF). At end of follow up twenty patients (30%) had discontinued flecainide treatment; of these seven patients (11%) had discontinued due to IRC. P-wave duration ≥130 ms (HR = 8.4, 95% CI 1.5–46), peak negative P-wave amplitude in V1 ≤ -100 μV (HR = 10, 95% CI 2.0–50) were significantly associated with discontinuation due to IRC in the univariate analysis. However, after adjusted analysis only peak negative P-wave amplitude in V1 ≤ -100 μV (HRadj = 28.7, 95% CI 3.13–263) remained significant.

Conclusion
Peak negative P-wave amplitude in V1 ≤ -100 μV was a risk factor for discontinuation due to inadequate rhythm control in long-term flecainide treated AF patients. (Less)
Please use this url to cite or link to this publication:
author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Electrocardiology
volume
85
pages
1 - 22
publisher
Elsevier
ISSN
1532-8430
DOI
10.1016/j.jelectrocard.2024.06.004
project
Medical treatment with Tambocor in atrial fibrillation, can we optimize the treatment?
Helsingborg Resuscitation and Cardiovascular Research Group
language
English
LU publication?
yes
id
e6e0f29c-4af9-4b49-bdf2-745d58cc477f
date added to LUP
2024-09-11 16:10:36
date last changed
2024-09-11 16:44:03
@misc{e6e0f29c-4af9-4b49-bdf2-745d58cc477f,
  abstract     = {{Background/introduction<br/>Flecainide is a commonly used efficient antiarrhythmic drug against atrial fibrillation (AF). P-wave indices reflect the atrial substrate and can predict incident AF, but their role as predictors of treatment outcomes for flecainide-treated AF patients are unknown.<br/><br/>Purpose<br/>To assess if P-wave indices can predict efficacy outcomes in long-term flecainide treated AF patients.<br/><br/>Methods<br/>Consecutive patients admitted for in-hospital flecainide initiation over a 5-year period were retrospectively included. Patient characteristics and baseline ECGs were collected (processed by the 12SL algorithm or manually measured). Echocardiographic measurements were collected up to 1.5 years before baseline. The study outcome was discontinuation of therapy due inadequate rhythm control (IRC). Cox regression analysis was adjusted for age, sex and left atrial volume index (LAVI).<br/><br/>Results<br/>Sixty-seven patients in sinus rhythm were included and followed up for a median of 1.5 years (mean age 59 ± 13 years, 36% females, AF history duration median of 3.0 years, 56% had ≤34 ml left atrial volume index (LAVI) and 9% had a history of persistent AF). At end of follow up twenty patients (30%) had discontinued flecainide treatment; of these seven patients (11%) had discontinued due to IRC. P-wave duration ≥130 ms (HR = 8.4, 95% CI 1.5–46), peak negative P-wave amplitude in V1 ≤ -100 μV (HR = 10, 95% CI 2.0–50) were significantly associated with discontinuation due to IRC in the univariate analysis. However, after adjusted analysis only peak negative P-wave amplitude in V1 ≤ -100 μV (HRadj = 28.7, 95% CI 3.13–263) remained significant.<br/><br/>Conclusion<br/>Peak negative P-wave amplitude in V1 ≤ -100 μV was a risk factor for discontinuation due to inadequate rhythm control in long-term flecainide treated AF patients.}},
  author       = {{Siotis, Alexander and Johansson, Samuel and Graff, Claus and Madsen Härdig, Bjarne and Platonov, Pyotr}},
  issn         = {{1532-8430}},
  language     = {{eng}},
  note         = {{Conference Abstract}},
  pages        = {{1--22}},
  publisher    = {{Elsevier}},
  series       = {{Journal of Electrocardiology}},
  title        = {{P-wave indices predict efficacy outcomes in long-term flecainide treated patients with atrial fibrillation}},
  url          = {{http://dx.doi.org/10.1016/j.jelectrocard.2024.06.004}},
  doi          = {{10.1016/j.jelectrocard.2024.06.004}},
  volume       = {{85}},
  year         = {{2024}},
}