Sol atriyal apendiks straini ve P dalga dispersiyonu: paroksismal atriyal fibrilasyonun elektro-mekanik belirteçleri

Year 2025, Volume: 6 Issue: 3, 199 - 206, 18.06.2025

Ayşe İrem Demirtola , Duygu İnan , Anar Mammadli , Eyüp Özkan , İsmail Balaban , İrem Müge Akbulut , Hüseyin Akgün , Gamze Acar , Gülnur Çolak , Ahmet Güler , Gökhan Kahvecı

https://doi.org/10.47582/jompac.1652473

Abstract

Giriş ve Amaç:
Paroksismal atriyal fibrilasyon (PAF), aralıklı doğası ve erken tespitinin zorluğu nedeniyle önemli bir klinik sorundur. Sol atriyal apendiks (LAA) fonksiyonu, atriyal mekanikte kritik bir rol oynarken, P dalga dispersiyonu (PWD) elektriksel inhomojeniteyi yansıtır. Bu çalışmada, LAA straini ve PWD’nin PAF tespitindeki öngörücü değerini değerlendirmeyi ve mekanik ile elektrofizyolojik parametreleri entegre eden bir prediktif model oluşturmayı amaçladık.

Yöntemler:
Gerçekleştirilen retrospektif analizde, 91 PAF ve 100 sinüs ritmindeki (SR) hasta olmak üzere toplam 191 hasta değerlendirildi. LAA fonksiyonu speckle-tracking ekokardiyografi ile, PWD ise 12 derivasyonlu EKG’den dijital olarak ölçüldü. Çok değişkenli lojistik regresyon modelleri oluşturuldu: Model 1’de klinik parametreler, Model 2’de ek olarak PWD, Model 3’te ise LAA strain rezervuar (LAA-Sr) eklendi.

Bulgular:
PAF hastaları, belirgin şekilde daha düşük LAA-Sr (%14,7 [12,2–18,0] vs. %21,6 [19,1–25,3], p < 0.001) ve daha yüksek PWD (30,3 [27,6–34,5] ms vs. 20,9 [17,3–26,6] ms, p < 0.001) değerlerine sahipti. Çok değişkenli analizde, LAA-Sr (OR: 1,315, %95 CI: 1,201–1,439, p < 0.001) ve PWD (OR: 1,128, %95 CI: 1,054–1,215, p = 0.038) bağımsız PAF prediktörleri olarak saptandı. Model 3, en iyi prediktif performansı gösterdi (AUC: 0.983, duyarlılık: %74, özgüllük: %72) ve Model 1 (AUC: 0.890) ile Model 2’ye (AUC: 0.950) kıyasla üstün bulundu.

Sonuç:
Çalışmamız, LAA straini ve PWD’nin PAF için güçlü ve bağımsız öngörücüler olduğunu ortaya koymaktadır. Mekanik ve elektrofizyolojik belirteçlerin kombinasyonu, AF risk sınıflandırmasını ve erken tespiti güçlendirebilir. Bu bulguların doğrulanması ve PAF risk değerlendirme stratejilerinin optimize edilmesi için gelecekte prospektif, çok merkezli çalışmalar gerekmektedir.

Keywords

Paroksismal atriyal fibrilasyon , Sol atriyal apendiks straini , P dalga dispersiyonu , Speckle-tracking ekokardiyografi , Atriyal fibrilasyon öngörüsü

Project Number

None

Left atrial appendage strain and P-wave dispersion: electro-mechanical markers of paroxysmal atrial fibrillation

Abstract

Aims: Paroxysmal atrial fibrillation (PAF) is a major clinical challenge due to its intermittent nature and the difficulty of early detection. Left atrial appendage (LAA) function plays a crucial role in atrial mechanics, while P-wave dispersion (PWD) reflects electrical inhomogeneity. We hypothesized that both parameters would independently and synergistically predict PAF and aimed to develop an integrative electro-mechanical model to enhance risk stratification.
Methods: We retrospectively analyzed 191 patients, including 91 with PAF and 100 in sinus rhythm (SR). LAA function was assessed using speckle-tracking echocardiography, and PWD was measured digitally from 12-lead electrocardiography. Multivariable logistic regression models were constructed: model 1 included clinical parameters, model 2 incorporated PWD, and Model 3 further added LAA strain reservoir (LAA-Sr)
Results: PAF patients exhibited significantly lower LAA-Sr (14.7 % [12.2-18.0] vs. 21.6% [19.1-25.3], p<0.001) and higher PWD (30.3 [27.6-34.5] ms vs. 20.9 [17.3-26.6] ms, p<0.001). In multivariable analysis, LAA-Sr (OR: 1.315, 95% confidence interval [CI]: 1.201-1.439, p<0.001) and PWD (OR: 1.128, 95% CI: 1.054-1.215, p=0.038) were independent PAF predictors. Model 3, which included both parameters, demonstrated the best predictive performance (AUC: 0.983, sensitivity: 92.8%, specificity: 79.4%) compared to model 1 (AUC: 0.890) and model 2 (AUC: 0.950).
Conclusion: Our study highlights LAA strain and PWD as robust, independent predictors of PAF. The combination of mechanical and electrophysiological markers enhances AF risk stratification and early detection. Future prospective, multicenter studies are warranted to validate these findings and optimize risk assessment strategies for PAF.

Keywords

Atrial fibrillation , left atrial appendage , transesophageal echocardiography , electrocardiography , prediction algorithms

Ethical Statement

Ethical approval for this study was obtained from the Başakşehir Çam and Sakura City Hospital Clinical Research Ethics Committee (Protocol No: 2022-136), and all procedures were conducted in accordance with the Declaration of Helsinki.

Supporting Institution

None

Project Number

None

Thanks

None

References

• Van Gelder IC, Rienstra M, Bunting K V, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314-3414. doi:10.1093/EURHEARTJ/EHAE176
• Imberti JF, Ding WY, Kotalczyk A, et al. Catheter ablation as first-line treatment for paroxysmal atrial fibrillation: a systematic review and meta-analysis. Heart. 2021;107(20):1630-1636. doi:10.1136/HEARTJNL- 2021-319496
• Liu R, Li Y. Morphology and function assessment of left atrial appendage in patients with atrial fibrillation. Echocardiography. 2024;41(11):e70013. doi:10.1111/ECHO.70013
• Muge A, Seda TK, Halil G, et al. Left atrial appendage orifice morphology in sickness and in health. Herz. 2025;50(3):185-191. doi:10.1007/S00059-024-05277-8
• Su B, Sun SK, Dai XJ, Ma CS, Zhou BY. The novel left atrial appendage strain parameters are associated with thrombosis risk in patients with non-valvular atrial fibrillation. Echocardiography. 2023;40(6):483-493. doi:10.1111/echo.15578
• Saberniak J, Skrebelyte-Strøm L, Orstad EB, et al. Left atrial appendage strain predicts subclinical atrial fibrillation in embolic strokes of undetermined source. Eur Heart J Open. 2023;3(3):oead039. doi:10.1093/ehjopen/oead039
• Censi F, Corazza I, Reggiani E, et al. P-wave variability and atrial fibrillation. Sci Rep. 2016;6:26799. doi:10.1038/SREP26799
• Pérez-Riera AR, de Abreu LC, Barbosa-Barros R, Grindler J, Fernandes-Cardoso A, Baranchuk A. P-wave dispersion: an update. Indian Pacing Electrophysiol J. 2016;16(4):126. doi:10.1016/J.IPEJ.2016.10.002
• Baumgartner H, de Backer J, Babu-Narayan S V, et al. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2021;42(6):563-645. doi:10.1093/EURHEARTJ/EHAA554
• Fatkin D, Kelly RP, Feneley MP. Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo. J Am Coll Cardiol. 1994;23(4):961-969. doi: 10.1016/0735-1097(94)90644-0
• Elm E von, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806. doi:10.1136/BMJ.39335.541782.AD
• Yang Y, Liu B, Ji W, Ding J, Tao S, Lian F. Comparison of left atrial and left atrial appendage mechanics in the recurrence of atrial fibrillation after radiofrequency catheter ablation. Echocardiography. 2023;40(10):1048-1057. doi:10.1111/ECHO.15670
• Saraçoglu E, Ural D, Kiliç S, Vuruskan E, Sahin T, Agir AA. Left atrial appendage 2D-strain assessed by transesophageal echocardiography is associated with thromboembolic risk in patients with atrial fibrillation. Turk Kardiyol Dern Ars. 2019;47(2):111-121. doi:10.5543/TKDA.2019.39482
• Wang L, Fan J, Wang Z, Liao Y, Zhou B, Ma C. Evaluating left atrial appendage function in a subtype of non-valvular atrial fibrillation using transesophageal echocardiography combined with two-dimensional speckle tracking. Quant Imaging Med Surg. 2022;12(5):2721-2731. doi: 10.21037/QIMS-21-942/COIF)
• Jankajova M, Kubikova L, Valocik G, et al. Left atrial appendage strain rate is associated with documented thromboembolism in nonvalvular atrial fibrillation. Wien Klin Wochenschr. 2019;131(7-8):156-164. doi:10. 1007/S00508-019-1469-6
• Aytemir K, Özer N, Atalar E, et al. P-wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol. 2000;23(7):1109-1112. doi:10.1111/J.1540-8159.2000.TB00910.X
• Liu P, Lv T, Yang Y, Gao Q, Zhang P. Use of P-wave indices to evaluate efficacy of catheter ablation and atrial fibrillation recurrence: a systematic review and meta-analysis. J Interv Card Electrophysiol. 2022; 65(3):827-840. doi:10.1007/S10840-022-01147-7
• Escudero-Martínez I, Morales-Caba L, Segura T. Atrial fibrillation and stroke: a review and new insights. Trends Cardiovasc Med. 2023;33(1):23-29. doi:10.1016/J.TCM.2021.12.001
• Zhang C, Kasner SE. Paroxysmal atrial fibrillation in cryptogenic stroke: an overlooked explanation? Curr Atheroscler Rep. 2015;17(12):66. doi:10.1007/S11883-015-0547-0