Correlation between P-wave parameters and atrioventricular synchrony in patients with leadless pacemakers

BACKGROUND: Correlation between P-wave parameters and atrioventricular synchrony (AVS) in patients with leadless pacemakers (LPs) remains controversial. The purpose of this study was to identify the correlation between P-wave parameters and AVS in patients with leadless pacemakers. METHOD: Patients undergoing VDD LP implantation at Beijing Anzhen Hospital between August 2022 to August 2024 were followed up at 1 month and 3 months after implantation, respectively. Demographic data, comorbidities, electrocardiogram parameters, echocardiography parameters, and programmable parameters were compared to those with Atrial-synchronized Ventricular Pacing (AsVP) ≥ 80% and those with AsVP < 80%. Logistic regression models were used to investigate the correlation between P-wave characteristics and AsVP. The AsVP and programmable parameters at 1 and 3 months were compared. RESULTS: 85 patients (average age 69.1 ± 14.1 years; 68.2% male) undergoing VDD LP implantation were divided into two groups based on AsVP (high AsVP ≥80% and low AsVP <80%). The high AsVP group exhibited significantly greater P-wave area as well as smaller P-wave dispersion (PD) on preoperative electrocardiogram (all P <0.05). Multivariate logistic analysis demonstrated that higher P-wave area and lower PD and E/A were independent predictor of high AsVP. Additionally, a greater AsVP was observed at 3 months compared to 1 month (80.9 ± 13.9% VS 74.6 ± 23.6%, P =0.035) after implantation. CONCLUSION: Preoperative electrocardiogram P-wave parameters may predict AVS after LP implantation. This finding helps us identify more suitable patients for receiving VDD LP.