Head-to-head comparison of non-invasive markers of atrial cardiomyopathy and their association with arrhythmia recurrence after atrial fibrillation ablation.

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.