What question did this study set out to answer?

The aim is to compare non-invasive markers for atrial cardiomyopathy and their association with arrhythmia recurrence post-ablation.

April 1, 2026Open Access

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

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation (n=200). Intervention: Amplified P-wave duration ≥ 150 ms vs. Amplified P-wave duration < 150 ms. Primary outcome: Relevant atrial cardiomyopathy (LA-LVS extent ≥ 20%) (OR 11.46, 95% CI 2.27-57.90, p=0.003).

Key Result

Amplified P-wave duration ≥ 150 ms was independently associated with relevant atrial cardiomyopathy (OR 11.46) and predicted arrhythmia recurrence (HR 2.01) in patients undergoing atrial fibrillation ablation.

Key Points

The aim is to compare non-invasive markers for atrial cardiomyopathy and their association with arrhythmia recurrence post-ablation.
Conducted in patients undergoing first-time atrial fibrillation ablation.
Evaluated PWD as a non-invasive marker.
Analyzed associations with left atrial volume and arrhythmia recurrence.
Amplified PWD was identified as the most reliable non-invasive marker of atrial cardiomyopathy.
It showed an independent association with invasively assessed left atrial volume and arrhythmia recurrence.
Highlighted the potential of advanced surface ECG analysis for clinical risk stratification.

Study Design

Type

Cohort (n=200)

Multicenter

Structured PICO

Does amplified P-wave duration predict relevant atrial cardiomyopathy and arrhythmia recurrence in patients with symptomatic atrial fibrillation undergoing first-time ablation?

Population

200 patients with symptomatic atrial fibrillation undergoing first-time pulmonary vein isolation with electroanatomical mapping, median age 69, 70% male

Intervention

Non-invasive markers of atrial cardiomyopathy (specifically amplified P-wave duration)

Outcome

Comparison of non-invasive markers of atrial cardiomyopathy with invasively quantified left atrial low-voltage substrate (LA-LVS extent)surrogate

Amplified P-wave duration ≥ 150 ms is a robust non-invasive marker for identifying relevant atrial cardiomyopathy and predicting arrhythmia recurrence after first-time AF ablation.

Main Result

Effect estimate: OR 11.46 (95% CI 2.27-57.90)

Absolute Event Rate: 58.5% vs 8.8%

p-value: p=0.003

Limitations

Single-center, retrospective study design
Voltage thresholds and mapping techniques remain subject to methodological variability
Tissue proximity index during EAM was not used in all procedures
Arrhythmia recurrence was assessed using intermittent rhythm monitoring, which may underestimate asymptomatic recurrences
Inclusion required the availability of a baseline ECG recorded in sinus rhythm, potentially introducing selection bias

Abstract

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.

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Cite This Study

Dippel et al. (Mon,) conducted a cohort in Atrial fibrillation (n=200). Amplified P-wave duration ≥ 150 ms vs. Amplified P-wave duration < 150 ms was evaluated on Relevant atrial cardiomyopathy (LA-LVS extent ≥ 20%) (OR 11.46, 95% CI 2.27-57.90, p=0.003). Amplified P-wave duration ≥ 150 ms was independently associated with relevant atrial cardiomyopathy (OR 11.46) and predicted arrhythmia recurrence (HR 2.01) in patients undergoing atrial fibrillation ablation.

synapsesocial.com/papers/69ccb72e16edfba7beb89013 https://doi.org/https://doi.org/10.1007/s00392-026-02908-4

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