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

Atrial Fibrillation (AF) is the most common cardiac arrhythmia, and its progressive nature is associated with gradual atrial remodeling. The P-wave in the surface Electrocardiogram (ECG) reflects the atrial activation, while the modification of the atrial pathophysiological properties leads to P-wave morphology (PWM) alternations. In paroxysmal AF (pAF), the modifications of the PWM may have a spontaneous rather than permanent presence in the ECG signal. The analysis of the P-waves, during sinus rhythm, on a beat-to-beat basis, has revealed the existence of at least two PWM. In addition, the wavelet characteristics of the P-wave matching the main morphology can accurately distinguish the patients with pAF from healthy volunteers. In this work, we examine the hypothesis that there is an effect of the anti-arrhythmic medication on beat-to-beat PWM alternations of pAF patients. ECG signals of high frequency (1000Hz), in the three orthogonal leads, were collected for 81 pAF patients of minimal and mild AF burden, 47 of which receiving antiarrhythmic medication treatment, and from 56 healthy volunteers. Kruskal-Wallis test was performed, and the preliminary results denote the existence of statistically significant differences between the groups. A 3-class Random Forest classifier was trained, using the forward wrapper approach, resulting in a high overall classification performance (AUC = 85.75%). This analysis is a step towards improving understanding of medication effect on the variability of P-wave.Clinical Relevance- The methodology presented in this paper can be used to perform a non-invasive characterization of low burden pAF patients using the ECG recording.