Clin Res Cardiol. 2026 Mar 30. doi: 10.1007/s00392-026-02908-4. Online ahead of print.
ABSTRACT
BACKGROUND: Atrial cardiomyopathy (AtCM) represents an important substrate underlying atrial fibrillation (AF), increased arrhythmia recurrence after catheter ablation, and other adverse outcomes. Several non-invasive markers have been proposed as surrogates of AtCM, but their comparative performance and clinical relevance remain insufficiently validated.
METHODS: In this retrospective study, 200 patients undergoing first-time catheter ablation for symptomatic AF were included. All patients underwent high-density left atrial electroanatomical mapping, which served as reference standard for AtCM assessment based on the extent of left atrial low-voltage substrate (LA-LVS). Non-invasive AtCM markers derived from 12-lead electrocardiography (ECG), transthoracic echocardiography, and blood-based biomarkers were systematically compared with LA-LVS extent and their predictive value for arrhythmia recurrence during follow-up was assessed.
RESULTS: Among non-invasive AtCM markers, amplified P-wave duration (PWD) and P-wave amplitude in lead I showed the strongest association with LA-LVS extent. In multivariable logistic regression analysis, prolonged amplified PWD (≥ 150 ms) was independently associated with relevant AtCM (odds ratio 11.46, 95% confidence interval 2.27-57.90, p = 0.003). During a median follow-up of 277 days, arrhythmia recurrence occurred in 21.9% of patients. In Cox regression analysis, amplified PWD ≥ 150 ms was the only non-invasive AtCM marker independently associated with arrhythmia recurrence (hazard ratio 2.01, 95% confidence interval 1.07-3.78, p = 0.031).
CONCLUSION: In patients undergoing first-time AF ablation, amplified PWD emerged as the most robust non-invasive marker of AtCM, independently associated with invasively assessed LA-LVS and arrhythmia recurrence. Advanced surface ECG analysis may represent a practical and widely applicable tool for AtCM-associated risk stratification in routine clinical practice.
PMID:41910775 | DOI:10.1007/s00392-026-02908-4