Abstract 16058: Abnormal P Wave Morphology is Associated With Decreased Left Atrial Appendage Ejection Velocity

Abstract

Introduction: P-wave abnormalities measured during periods of sinus rhythm have been associated stroke in people with atrial fibrillation (AF). The majority of AF-related strokes occur from left atrial appendage (LAA) thromboembolism. Electrical and mechanical dysfunction of the left atrium (LA) and left atrial appendage (LAA) can lower the threshold for thromboembolism and stroke. Hypothesis: We aimed to determine whether P-wave abnormalities are associated with decreased LAA ejection velocity (LAAV) on transesophageal echocardiography (TEE). Methods: We conducted a retrospective cross-sectional study. We reviewed patients at a tertiary care medical center who had underwent TEE in sinus rhythm and had an interpretable sinus rhythm ECG within 12 months of TEE. Participants were excluded for history of complex congenital heart disease, age<18, cardiac transplantation, and atrial pacing. Logistic regression analysis was used to estimate the odds ratios of LAAV<40 cm/s for P-wave abnormalities—advanced interatrial block (aIAB), abnormal P-wave terminal force in V1 (aPTFV1), prolonged P-wave duration (PPWD), and abnormal P-wave axis (aPWA). Results: In our final cohort of 169 patients, the odds ratios of aIAB and aPTFV1 for LAAV<40 cm/s after adjustment for CHA 2 DS 2 VASc variables, heart rate during TEE, history of atrial arrhythmias, and left atrial volume index were 2.81 (1.07-7.53) and 2.48 (1.13-5.60), respectively. Conclusions: P-wave abnormalities are independently associated with low LAAV, which may explain their association with AF-related stroke. Further research is needed to determine if incorporation of P-wave analysis will aid AF-related stroke prediction algorithms.