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We hypothesized that changes in fWA following wide circumferential isolation of pulmonary veins (WPVI) in persistent AF (peAF) is a better predictor of ablation outcome compared to baseline fWA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Eighty-nine patients (sustained peAF 7\u2009\u00b1\u20097\u00a0months) underwent a first-time WPVI. Sixty-second ECG signals devoid of QRST waves were recorded at baseline and at the end of the WPVI (endWPVI). fWA for each ECG lead and mean fWA (meanfWA) across the 12-lead ECG were computed. Patients with recurrence after the index WPVI underwent a redo to ensure complete PVI. The primary endpoint was long-term AF freedom OFF antiarrhythmics drugs (AADs) after one or two WPVI (SUCCESS group). The FAILURE group was defined as AF recurrence post-redo.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Over a mean follow-up of 35\u2009\u00b1\u200910\u00a0months, freedom from AF OFF AADs was achieved in 61% (SUCCESS group), while 29% had AF recurrence after redo WPVI (FAILURE group). The SUCCESS group showed significantly higher fWA values in ECG leads V\n                      <jats:sub>1<\/jats:sub>\n                      , V\n                      <jats:sub>4<\/jats:sub>\n                      , and V\n                      <jats:sub>5<\/jats:sub>\n                      at baseline (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05), as well as in leads III, aVL, aVF, and V\n                      <jats:sub>4<\/jats:sub>\n                      , and in meanfWA at endWPVI (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05) compared to the FAILURE group. A baseline mean fWA\u2009\u2265\u20090.044\u00a0mV or a decrease in mean fWA\u2009\u2264\u200911% following WPVI predicted long-term sinus rhythm restoration with a sensitivity of 81% and a specificity of 69% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Low fWA values and a significant reduction in fWA following WPVI are associated with a high risk of AF recurrence in patients with peAF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                    <jats:p>Fibrillatory wave amplitude changes after WPVI can predict long-term sinus rhythm maintenance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10840-025-02018-7","type":"journal-article","created":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T05:48:22Z","timestamp":1739944102000},"page":"1243-1255","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Predicting outcomes in persistent atrial fibrillation: the impact of surface ECG f-wave amplitude following pulmonary vein isolation"],"prefix":"10.1007","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9947-085X","authenticated-orcid":false,"given":"Aruran","family":"Baskaralingam","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Marchetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Solana-Munoz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl","family":"Teres","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathieu","family":"Le Bloa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra Pia","family":"Porretta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Domenichini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciro","family":"Ascione","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Roten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Knecht","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"K\u00fchne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Sticherling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrizio","family":"Pascale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Etienne","family":"Pruvot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Luca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,2,19]]},"reference":[{"issue":"4","key":"2018_CR1","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1001\/jama.2009.2029","volume":"303","author":"DJ Wilber","year":"2010","unstructured":"Wilber DJ, Pappone C, Neuzil P, De Paola A, Marchlinski F, Natale A, et al. 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Roten has received research grants from Medtronic, the Swiss National Foundation, the Swiss Heart Foundation, the Immanuel and Ilse Straub Foundation, and the Sitem Insel Support Fund, all for work outside the submitted study. He has received speaker fees\/honoraria from Biosense Webster, Boston Scientific, Abbott, and Medtronic. S. Knecht has received research grants from the Swiss Heart Foundation for work outside the submitted study. All remaining authors declare that they have no conflicts of interest, no relevant financial or non-financial interests to disclose related to the content of this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}