Abstract
Atrial fibrillation (AF) is associated with an increased risk of ischemic stroke, heart failure, cognitive decline, dementia, myocardial infarction, sudden cardiac death (SCD), and all-cause death. Although these associations are firmly established, our understanding of the underlying mechanisms remains incomplete. Accumulating evidence suggests that left atrial (LA) abnormality or atrial cardiomyopathy may explain the relationship of AF to the aforementioned outcomes. P-wave indices (PWIs) reflect underlying atrial remodeling. In this mini review, we define representative PWIs, discuss state-of-the-art knowledge on the relationship between abnormal PWIs and AF-related cardiovascular outcomes (focusing on ischemic stroke and sudden cardiac death), and propose directions for future research. Our ultimate goal is to present a practical way forward to advance the emerging field of LA abnormality or atrial cardiomyopathy.
Highlights
Reviewed by: Alexander Maass, University Medical Center Groningen, Netherlands Jose Francisco Huizar, Hunter Holmes McGuire VA Medical Center, United States
Using data from two prospective community-based cohort studies— Atherosclerosis Risk in Communities (ARIC) and Multi-Ethnic Study of Atherosclerosis (MESA)—Maheshwari et al found that of the P-wave indices (PWIs) considered (P-wave axis, P-wave duration, advanced interatrial block (aIAB), and P-wave terminal force in lead V1 (PTFV1)), abnormal P-wave axis was the only PWI associated with increased ischemic stroke risk independent of CHA2DS2VASc variables, and that resulted in meaningful improvement in stroke prediction
We propose additional investigation in the following areas to advance our understanding of Atrial fibrillation (AF)-related cardiovascular outcomes
Summary
Reviewed by: Alexander Maass, University Medical Center Groningen, Netherlands Jose Francisco Huizar, Hunter Holmes McGuire VA Medical Center, United States. Atrial fibrillation (AF) is associated with an increased risk of ischemic stroke, heart failure, cognitive decline, dementia, myocardial infarction, sudden cardiac death (SCD), and all-cause death.
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