P-wave abnormalities in PRKAG2 cardiomyopathy: Expanding the electrocardiographic spectrum beyond preexcitation and hypertrophy.

PRKAG2 cardiomyopathy exhibits distinctive P-wave abnormalities-including notching, axis deviation, inter-atrial block, and enlarged P-wave terminal force in lead V1 (PTFV1)-that reflect underlying atrial involvement. These atrial electrocardiographic features, when integrated with comprehensive genetic testing, may enable earlier diagnosis, facilitating accurate genotype-phenotype correlation and refined risk stratification beyond traditional preexcitation or hypertrophy patterns, ultimately guiding timely intervention and family screening in this rare but potentially malignant inherited cardiac disorder.