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Background <p>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.</p> Methods <p>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.</p> Results <p>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&#xa0;ms) was independently associated with relevant AtCM (odds ratio 11.46, 95% confidence interval 2.27–57.90, <i>p</i> = 0.003). During a median follow-up of 277&#xa0;days, arrhythmia recurrence occurred in 21.9% of patients. In Cox regression analysis, amplified PWD ≥ 150&#xa0;ms was the only non-invasive AtCM marker independently associated with arrhythmia recurrence (hazard ratio 2.01, 95% confidence interval 1.07–3.78, <i>p </i>= 0.031).</p> Conclusion <p>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.</p> Graphical abstract <p></p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月30日

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  • Laura Dippel,
  • Denis Fedorov,
  • Julian Müller,
  • Amir Jadidi,
  • Dirk Westermann,
  • Heiko Lehrmann,
  • Thomas Arentz,
  • Martin Eichenlaub

摘要

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.

Graphical abstract