P-wave vector magnitude predicts the left atrial low-voltage area in patients with paroxysmal atrial fibrillation

Background: P-wave amplitude (PWA) parameters can be the surrogate measures of the left atrial low-voltage areas (LVAs). Methods: We measured PWAs using an automated system in 50 patients with paroxysmal atrial fibrillation (AF). We examined the relationships between left atrial LVAs and PWA parameters, including P-wave vector magnitude, calculated as the square root of the sum of lead II PWA squared, lead V6 PWA squared, and a one-half lead V2 PWA squared. Results: Lead I PWA was most strongly correlated with LVAs in the anterior wall and appendage (anterior wall, R = −0.391, P = 0.006; appendage, R = −0.342, P = 0.016), whereas lead II PWA was most strongly correlated with LVAs in the septum, posterior wall, and bottom wall (septum, R = −0.413, P = 0.003; posterior wall, R = −0.297, P = 0.039; bottom wall; R = −0.288, P = 0.045). Although maximum, minimum, mean, and lead I PWAs were not correlated with total LVA, P-wave vector magnitude and lead II PWA were significantly correlated with total LVA (P-wave vector magnitude, R = −0.430, P = 0.002; lead II PWA, R = −0.323, P = 0.023). P-wave vector magnitude achieved the highest accuracy for predicting significant LVA (total LVA > 10%) with an area under the curve of 0.772; sensitivity, specificity, and positive and negative predictive values were 64%, 88%, 85%, and 69%, respectively, for the cutoff value of 0.130 mV. Conclusion: P-wave vector magnitude is a useful electrocardiographic predictor of left atrial LVAs.