Abstract 17241: Electrocardiographic Left Atrial Abnormalities and Risk of Stroke in Patients With Atrial Fibrillation
Introduction: Mounting evidence suggests that left atrial (LA) structural remodeling plays an important role in the mechanism of stroke in patients with a history of atrial fibrillation (AF). We evaluated the association among the severity of LA abnormality on electrocardiogram (ECG), the severity of LA structural remodeling by cardiac magnetic resonance (CMR), and a history of stroke or transient ischemic attack in patients with AF referred for catheter ablation.
Methods: A total of 229 consecutive patients (age 60±10 years, 72% male) referred for catheter ablation of AF who were in sinus rhythm at the time of pre-ablation ECG recording and CMR were included, with (n=21; the stroke group) and without (n=208; control group) a history of stroke or TIA. The severity of LA abnormality on ECG was quantified from the P wave terminal force in lead V1 (PTFV1).
Results: In the stroke group, PTFV1 was significantly higher compared with the control group (8,107±5,921 vs. 4,865±3,205μV*ms; p<0.001). In linear regression analyses, each increase in the LA minimum volume (mL/m2) and decrease in left ventricular ejection fraction (%) were associated with an increase in PTFV1 (47.7 and 74,1μV*ms; p=0.027 and 0.005, respectively). Multivariable analysis demonstrated that the PTFV1 and LA emptying fraction were associated with a history of stroke (odds ratio 1.23 and 0.94; p=0.002 and 0.037, respectively) after adjusting for the CHA2DS2-VASc score and the LA minimum volume.
Conclusions: PTFV1 is an independent marker of stroke, and provides an incremental value to the CHA2DS2-VASc score in patients with AF. Evaluation of LA abnormalities by 12-lead ECG may improve the current risk stratification of stroke in patients with AF.
Author Disclosures: Y. Inoue: None. E.G. Ipek: None. L. Ciuffo: None. J. Chrispin: None. I.M. Khurram: None. M. Habibi: None. S.L. Zimmerman: None. J.E. Marine: None. J. Rickard: None. D.D. Spragg: None. S. Nazarian: None. J.A. Lima: None. R.D. Berger: None. H. Calkins: None. H. Ashikaga: None.
- © 2016 by American Heart Association, Inc.