JOMPAC
Journal of Medicine and Palliative Care

Journal of Medicine and Palliative Care (JOMPAC) is an open access scientific journal with independent, unbiased, and double-blind review under international guidelines. The purpose of JOMPAC is to contribute to the literature by publishing articles on health sciences and medicine.

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Original Article
Left atrial appendage strain and P-wave dispersion: electro-mechanical markers of paroxysmal atrial fibrillation
Abstract
Aims: Paroxysmal atrial fibrillation (PAF) is a major clinical challenge due to its intermittent nature and the difficulty of early detection. Left atrial appendage (LAA) function plays a crucial role in atrial mechanics, while P-wave dispersion (PWD) reflects electrical inhomogeneity. We hypothesized that both parameters would independently and synergistically predict PAF and aimed to develop an integrative electro-mechanical model to enhance risk stratification.
Methods: We retrospectively analyzed 191 patients, including 91 with PAF and 100 in sinus rhythm (SR). LAA function was assessed using speckle-tracking echocardiography, and PWD was measured digitally from 12-lead electrocardiography. Multivariable logistic regression models were constructed: model 1 included clinical parameters, model 2 incorporated PWD, and Model 3 further added LAA strain reservoir (LAA-Sr).
Results: PAF patients exhibited significantly lower LAA-Sr (14.7 % [12.2-18.0] vs. 21.6% [19.1-25.3], p<0.001) and higher PWD (30.3 [27.6-34.5] ms vs. 20.9 [17.3-26.6] ms, p<0.001). In multivariable analysis, LAA-Sr (OR: 1.315, 95% confidence interval [CI]: 1.201-1.439, p<0.001) and PWD (OR: 1.128, 95% CI: 1.054-1.215, p=0.038) were independent PAF predictors. Model 3, which included both parameters, demonstrated the best predictive performance (AUC: 0.983, sensitivity: 92.8%, specificity: 79.4%) compared to model 1 (AUC: 0.890) and model 2 (AUC: 0.950).
Conclusion: Our study highlights LAA strain and PWD as robust, independent predictors of PAF. The combination of mechanical and electrophysiological markers enhances AF risk stratification and early detection. Future prospective, multi-center studies are warranted to validate these findings and optimize risk assessment strategies for PAF.

Keywords : Atrial fibrillation, left atrial appendage, transesophageal echocardiography, electrocardiography, prediction algorithms

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1. Van Gelder IC, Rienstra M, Bunting K V, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314-3414. doi:10.1093/EURHEARTJ/EHAE176
2. Imberti JF, Ding WY, Kotalczyk A, et al. Catheter ablation as first-line treatment for paroxysmal atrial fibrillation: a systematic review and meta-analysis. Heart. 2021;107(20):1630-1636. doi:10.1136/HEARTJNL- 2021-319496
3. Liu R, Li Y. Morphology and function assessment of left atrial appendage in patients with atrial fibrillation. Echocardiography. 2024;41(11):e70013. doi:10.1111/ECHO.70013
4. Muge A, Seda TK, Halil G, et al. Left atrial appendage orifice morphology in sickness and in health. Herz. 2025;50(3):185-191. doi:10.1007/S00059-024-05277-8
5. Su B, Sun SK, Dai XJ, Ma CS, Zhou BY. The novel left atrial appendage strain parameters are associated with thrombosis risk in patients with non-valvular atrial fibrillation. Echocardiography. 2023;40(6):483-493. doi:10.1111/echo.15578
6. Saberniak J, Skrebelyte-Strøm L, Orstad EB, et al. Left atrial appendage strain predicts subclinical atrial fibrillation in embolic strokes of undetermined source. Eur Heart J Open. 2023;3(3):oead039. doi:10.1093/ehjopen/oead039
7. Censi F, Corazza I, Reggiani E, et al. P-wave variability and atrial fibrillation. Sci Rep. 2016;6:26799. doi:10.1038/SREP26799
8. Pérez-Riera AR, de Abreu LC, Barbosa-Barros R, Grindler J, Fernandes-Cardoso A, Baranchuk A. P-wave dispersion: an update. Indian Pacing Electrophysiol J. 2016;16(4):126. doi:10.1016/J.IPEJ.2016.10.002
9. Baumgartner H, de Backer J, Babu-Narayan S V, et al. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2021;42(6):563-645. doi:10.1093/EURHEARTJ/EHAA554
10. Fatkin D, Kelly RP, Feneley MP. Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo. J Am Coll Cardiol. 1994;23(4):961-969. doi: 10.1016/0735-1097(94)90644-0
11. Elm E von, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806. doi:10.1136/BMJ.39335.541782.AD
12. Yang Y, Liu B, Ji W, Ding J, Tao S, Lian F. Comparison of left atrial and left atrial appendage mechanics in the recurrence of atrial fibrillation after radiofrequency catheter ablation. Echocardiography. 2023;40(10):1048-1057. doi:10.1111/ECHO.15670
13. Saraçoglu E, Ural D, Kiliç S, Vuruskan E, Sahin T, Agir AA. Left atrial appendage 2D-strain assessed by transesophageal echocardiography is associated with thromboembolic risk in patients with atrial fibrillation. Turk Kardiyol Dern Ars. 2019;47(2):111-121. doi:10.5543/TKDA.2019.39482
14. Wang L, Fan J, Wang Z, Liao Y, Zhou B, Ma C. Evaluating left atrial appendage function in a subtype of non-valvular atrial fibrillation using transesophageal echocardiography combined with two-dimensional speckle tracking. Quant Imaging Med Surg. 2022;12(5):2721-2731. doi: 10.21037/QIMS-21-942/COIF)
15. Jankajova M, Kubikova L, Valocik G, et al. Left atrial appendage strain rate is associated with documented thromboembolism in nonvalvular atrial fibrillation. Wien Klin Wochenschr. 2019;131(7-8):156-164. doi:10. 1007/S00508-019-1469-6
16. Aytemir K, Özer N, Atalar E, et al. P-wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol. 2000;23(7):1109-1112. doi:10.1111/J.1540-8159.2000.TB00910.X
17. Liu P, Lv T, Yang Y, Gao Q, Zhang P. Use of P-wave indices to evaluate efficacy of catheter ablation and atrial fibrillation recurrence: a systematic review and meta-analysis. J Interv Card Electrophysiol. 2022; 65(3):827-840. doi:10.1007/S10840-022-01147-7
18. Escudero-Martínez I, Morales-Caba L, Segura T. Atrial fibrillation and stroke: a review and new insights. Trends Cardiovasc Med. 2023;33(1):23-29. doi:10.1016/J.TCM.2021.12.001
19. Zhang C, Kasner SE. Paroxysmal atrial fibrillation in cryptogenic stroke: an overlooked explanation? Curr Atheroscler Rep. 2015;17(12):66. doi:10.1007/S11883-015-0547-0
1. Van Gelder IC, Rienstra M, Bunting K V, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314-3414. doi:10.1093/EURHEARTJ/EHAE176
2. Imberti JF, Ding WY, Kotalczyk A, et al. Catheter ablation as first-line treatment for paroxysmal atrial fibrillation: a systematic review and meta-analysis. Heart. 2021;107(20):1630-1636. doi:10.1136/HEARTJNL- 2021-319496
3. Liu R, Li Y. Morphology and function assessment of left atrial appendage in patients with atrial fibrillation. Echocardiography. 2024;41(11):e70013. doi:10.1111/ECHO.70013
4. Muge A, Seda TK, Halil G, et al. Left atrial appendage orifice morphology in sickness and in health. Herz. 2025;50(3):185-191. doi:10.1007/S00059-024-05277-8
5. Su B, Sun SK, Dai XJ, Ma CS, Zhou BY. The novel left atrial appendage strain parameters are associated with thrombosis risk in patients with non-valvular atrial fibrillation. Echocardiography. 2023;40(6):483-493. doi:10.1111/echo.15578
6. Saberniak J, Skrebelyte-Strøm L, Orstad EB, et al. Left atrial appendage strain predicts subclinical atrial fibrillation in embolic strokes of undetermined source. Eur Heart J Open. 2023;3(3):oead039. doi:10.1093/ehjopen/oead039
7. Censi F, Corazza I, Reggiani E, et al. P-wave variability and atrial fibrillation. Sci Rep. 2016;6:26799. doi:10.1038/SREP26799
8. Pérez-Riera AR, de Abreu LC, Barbosa-Barros R, Grindler J, Fernandes-Cardoso A, Baranchuk A. P-wave dispersion: an update. Indian Pacing Electrophysiol J. 2016;16(4):126. doi:10.1016/J.IPEJ.2016.10.002
9. Baumgartner H, de Backer J, Babu-Narayan S V, et al. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2021;42(6):563-645. doi:10.1093/EURHEARTJ/EHAA554
10. Fatkin D, Kelly RP, Feneley MP. Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo. J Am Coll Cardiol. 1994;23(4):961-969. doi: 10.1016/0735-1097(94)90644-0
11. Elm E von, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806. doi:10.1136/BMJ.39335.541782.AD
12. Yang Y, Liu B, Ji W, Ding J, Tao S, Lian F. Comparison of left atrial and left atrial appendage mechanics in the recurrence of atrial fibrillation after radiofrequency catheter ablation. Echocardiography. 2023;40(10):1048-1057. doi:10.1111/ECHO.15670
13. Saraçoglu E, Ural D, Kiliç S, Vuruskan E, Sahin T, Agir AA. Left atrial appendage 2D-strain assessed by transesophageal echocardiography is associated with thromboembolic risk in patients with atrial fibrillation. Turk Kardiyol Dern Ars. 2019;47(2):111-121. doi:10.5543/TKDA.2019.39482
14. Wang L, Fan J, Wang Z, Liao Y, Zhou B, Ma C. Evaluating left atrial appendage function in a subtype of non-valvular atrial fibrillation using transesophageal echocardiography combined with two-dimensional speckle tracking. Quant Imaging Med Surg. 2022;12(5):2721-2731. doi: 10.21037/QIMS-21-942/COIF)
15. Jankajova M, Kubikova L, Valocik G, et al. Left atrial appendage strain rate is associated with documented thromboembolism in nonvalvular atrial fibrillation. Wien Klin Wochenschr. 2019;131(7-8):156-164. doi:10. 1007/S00508-019-1469-6
16. Aytemir K, Özer N, Atalar E, et al. P-wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol. 2000;23(7):1109-1112. doi:10.1111/J.1540-8159.2000.TB00910.X
17. Liu P, Lv T, Yang Y, Gao Q, Zhang P. Use of P-wave indices to evaluate efficacy of catheter ablation and atrial fibrillation recurrence: a systematic review and meta-analysis. J Interv Card Electrophysiol. 2022; 65(3):827-840. doi:10.1007/S10840-022-01147-7
18. Escudero-Martínez I, Morales-Caba L, Segura T. Atrial fibrillation and stroke: a review and new insights. Trends Cardiovasc Med. 2023;33(1):23-29. doi:10.1016/J.TCM.2021.12.001
19. Zhang C, Kasner SE. Paroxysmal atrial fibrillation in cryptogenic stroke: an overlooked explanation? Curr Atheroscler Rep. 2015;17(12):66. doi:10.1007/S11883-015-0547-0
1. Van Gelder IC, Rienstra M, Bunting K V, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314-3414. doi:10.1093/EURHEARTJ/EHAE176
2. Imberti JF, Ding WY, Kotalczyk A, et al. Catheter ablation as first-line treatment for paroxysmal atrial fibrillation: a systematic review and meta-analysis. Heart. 2021;107(20):1630-1636. doi:10.1136/HEARTJNL- 2021-319496
3. Liu R, Li Y. Morphology and function assessment of left atrial appendage in patients with atrial fibrillation. Echocardiography. 2024;41(11):e70013. doi:10.1111/ECHO.70013
4. Muge A, Seda TK, Halil G, et al. Left atrial appendage orifice morphology in sickness and in health. Herz. 2025;50(3):185-191. doi:10.1007/S00059-024-05277-8
5. Su B, Sun SK, Dai XJ, Ma CS, Zhou BY. The novel left atrial appendage strain parameters are associated with thrombosis risk in patients with non-valvular atrial fibrillation. Echocardiography. 2023;40(6):483-493. doi:10.1111/echo.15578
6. Saberniak J, Skrebelyte-Strøm L, Orstad EB, et al. Left atrial appendage strain predicts subclinical atrial fibrillation in embolic strokes of undetermined source. Eur Heart J Open. 2023;3(3):oead039. doi:10.1093/ehjopen/oead039
7. Censi F, Corazza I, Reggiani E, et al. P-wave variability and atrial fibrillation. Sci Rep. 2016;6:26799. doi:10.1038/SREP26799
8. Pérez-Riera AR, de Abreu LC, Barbosa-Barros R, Grindler J, Fernandes-Cardoso A, Baranchuk A. P-wave dispersion: an update. Indian Pacing Electrophysiol J. 2016;16(4):126. doi:10.1016/J.IPEJ.2016.10.002
9. Baumgartner H, de Backer J, Babu-Narayan S V, et al. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2021;42(6):563-645. doi:10.1093/EURHEARTJ/EHAA554
10. Fatkin D, Kelly RP, Feneley MP. Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo. J Am Coll Cardiol. 1994;23(4):961-969. doi: 10.1016/0735-1097(94)90644-0
11. Elm E von, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806. doi:10.1136/BMJ.39335.541782.AD
12. Yang Y, Liu B, Ji W, Ding J, Tao S, Lian F. Comparison of left atrial and left atrial appendage mechanics in the recurrence of atrial fibrillation after radiofrequency catheter ablation. Echocardiography. 2023;40(10):1048-1057. doi:10.1111/ECHO.15670
13. Saraçoglu E, Ural D, Kiliç S, Vuruskan E, Sahin T, Agir AA. Left atrial appendage 2D-strain assessed by transesophageal echocardiography is associated with thromboembolic risk in patients with atrial fibrillation. Turk Kardiyol Dern Ars. 2019;47(2):111-121. doi:10.5543/TKDA.2019.39482
14. Wang L, Fan J, Wang Z, Liao Y, Zhou B, Ma C. Evaluating left atrial appendage function in a subtype of non-valvular atrial fibrillation using transesophageal echocardiography combined with two-dimensional speckle tracking. Quant Imaging Med Surg. 2022;12(5):2721-2731. doi: 10.21037/QIMS-21-942/COIF)
15. Jankajova M, Kubikova L, Valocik G, et al. Left atrial appendage strain rate is associated with documented thromboembolism in nonvalvular atrial fibrillation. Wien Klin Wochenschr. 2019;131(7-8):156-164. doi:10. 1007/S00508-019-1469-6
16. Aytemir K, Özer N, Atalar E, et al. P-wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol. 2000;23(7):1109-1112. doi:10.1111/J.1540-8159.2000.TB00910.X
17. Liu P, Lv T, Yang Y, Gao Q, Zhang P. Use of P-wave indices to evaluate efficacy of catheter ablation and atrial fibrillation recurrence: a systematic review and meta-analysis. J Interv Card Electrophysiol. 2022; 65(3):827-840. doi:10.1007/S10840-022-01147-7
18. Escudero-Martínez I, Morales-Caba L, Segura T. Atrial fibrillation and stroke: a review and new insights. Trends Cardiovasc Med. 2023;33(1):23-29. doi:10.1016/J.TCM.2021.12.001
19. Zhang C, Kasner SE. Paroxysmal atrial fibrillation in cryptogenic stroke: an overlooked explanation? Curr Atheroscler Rep. 2015;17(12):66. doi:10.1007/S11883-015-0547-0
1. Van Gelder IC, Rienstra M, Bunting K V, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314-3414. doi:10.1093/EURHEARTJ/EHAE176
2. Imberti JF, Ding WY, Kotalczyk A, et al. Catheter ablation as first-line treatment for paroxysmal atrial fibrillation: a systematic review and meta-analysis. Heart. 2021;107(20):1630-1636. doi:10.1136/HEARTJNL- 2021-319496
3. Liu R, Li Y. Morphology and function assessment of left atrial appendage in patients with atrial fibrillation. Echocardiography. 2024;41(11):e70013. doi:10.1111/ECHO.70013
4. Muge A, Seda TK, Halil G, et al. Left atrial appendage orifice morphology in sickness and in health. Herz. 2025;50(3):185-191. doi:10.1007/S00059-024-05277-8
5. Su B, Sun SK, Dai XJ, Ma CS, Zhou BY. The novel left atrial appendage strain parameters are associated with thrombosis risk in patients with non-valvular atrial fibrillation. Echocardiography. 2023;40(6):483-493. doi:10.1111/echo.15578
6. Saberniak J, Skrebelyte-Strøm L, Orstad EB, et al. Left atrial appendage strain predicts subclinical atrial fibrillation in embolic strokes of undetermined source. Eur Heart J Open. 2023;3(3):oead039. doi:10.1093/ehjopen/oead039
7. Censi F, Corazza I, Reggiani E, et al. P-wave variability and atrial fibrillation. Sci Rep. 2016;6:26799. doi:10.1038/SREP26799
8. Pérez-Riera AR, de Abreu LC, Barbosa-Barros R, Grindler J, Fernandes-Cardoso A, Baranchuk A. P-wave dispersion: an update. Indian Pacing Electrophysiol J. 2016;16(4):126. doi:10.1016/J.IPEJ.2016.10.002
9. Baumgartner H, de Backer J, Babu-Narayan S V, et al. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2021;42(6):563-645. doi:10.1093/EURHEARTJ/EHAA554
10. Fatkin D, Kelly RP, Feneley MP. Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo. J Am Coll Cardiol. 1994;23(4):961-969. doi: 10.1016/0735-1097(94)90644-0
11. Elm E von, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806. doi:10.1136/BMJ.39335.541782.AD
12. Yang Y, Liu B, Ji W, Ding J, Tao S, Lian F. Comparison of left atrial and left atrial appendage mechanics in the recurrence of atrial fibrillation after radiofrequency catheter ablation. Echocardiography. 2023;40(10):1048-1057. doi:10.1111/ECHO.15670
13. Saraçoglu E, Ural D, Kiliç S, Vuruskan E, Sahin T, Agir AA. Left atrial appendage 2D-strain assessed by transesophageal echocardiography is associated with thromboembolic risk in patients with atrial fibrillation. Turk Kardiyol Dern Ars. 2019;47(2):111-121. doi:10.5543/TKDA.2019.39482
14. Wang L, Fan J, Wang Z, Liao Y, Zhou B, Ma C. Evaluating left atrial appendage function in a subtype of non-valvular atrial fibrillation using transesophageal echocardiography combined with two-dimensional speckle tracking. Quant Imaging Med Surg. 2022;12(5):2721-2731. doi: 10.21037/QIMS-21-942/COIF)
15. Jankajova M, Kubikova L, Valocik G, et al. Left atrial appendage strain rate is associated with documented thromboembolism in nonvalvular atrial fibrillation. Wien Klin Wochenschr. 2019;131(7-8):156-164. doi:10. 1007/S00508-019-1469-6
16. Aytemir K, Özer N, Atalar E, et al. P-wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol. 2000;23(7):1109-1112. doi:10.1111/J.1540-8159.2000.TB00910.X
17. Liu P, Lv T, Yang Y, Gao Q, Zhang P. Use of P-wave indices to evaluate efficacy of catheter ablation and atrial fibrillation recurrence: a systematic review and meta-analysis. J Interv Card Electrophysiol. 2022; 65(3):827-840. doi:10.1007/S10840-022-01147-7
18. Escudero-Martínez I, Morales-Caba L, Segura T. Atrial fibrillation and stroke: a review and new insights. Trends Cardiovasc Med. 2023;33(1):23-29. doi:10.1016/J.TCM.2021.12.001
19. Zhang C, Kasner SE. Paroxysmal atrial fibrillation in cryptogenic stroke: an overlooked explanation? Curr Atheroscler Rep. 2015;17(12):66. doi:10.1007/S11883-015-0547-0
1. Van Gelder IC, Rienstra M, Bunting K V, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314-3414. doi:10.1093/EURHEARTJ/EHAE176
2. Imberti JF, Ding WY, Kotalczyk A, et al. Catheter ablation as first-line treatment for paroxysmal atrial fibrillation: a systematic review and meta-analysis. Heart. 2021;107(20):1630-1636. doi:10.1136/HEARTJNL- 2021-319496
3. Liu R, Li Y. Morphology and function assessment of left atrial appendage in patients with atrial fibrillation. Echocardiography. 2024;41(11):e70013. doi:10.1111/ECHO.70013
4. Muge A, Seda TK, Halil G, et al. Left atrial appendage orifice morphology in sickness and in health. Herz. 2025;50(3):185-191. doi:10.1007/S00059-024-05277-8
5. Su B, Sun SK, Dai XJ, Ma CS, Zhou BY. The novel left atrial appendage strain parameters are associated with thrombosis risk in patients with non-valvular atrial fibrillation. Echocardiography. 2023;40(6):483-493. doi:10.1111/echo.15578
6. Saberniak J, Skrebelyte-Strøm L, Orstad EB, et al. Left atrial appendage strain predicts subclinical atrial fibrillation in embolic strokes of undetermined source. Eur Heart J Open. 2023;3(3):oead039. doi:10.1093/ehjopen/oead039
7. Censi F, Corazza I, Reggiani E, et al. P-wave variability and atrial fibrillation. Sci Rep. 2016;6:26799. doi:10.1038/SREP26799
8. Pérez-Riera AR, de Abreu LC, Barbosa-Barros R, Grindler J, Fernandes-Cardoso A, Baranchuk A. P-wave dispersion: an update. Indian Pacing Electrophysiol J. 2016;16(4):126. doi:10.1016/J.IPEJ.2016.10.002
9. Baumgartner H, de Backer J, Babu-Narayan S V, et al. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2021;42(6):563-645. doi:10.1093/EURHEARTJ/EHAA554
10. Fatkin D, Kelly RP, Feneley MP. Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo. J Am Coll Cardiol. 1994;23(4):961-969. doi: 10.1016/0735-1097(94)90644-0
11. Elm E von, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806. doi:10.1136/BMJ.39335.541782.AD
12. Yang Y, Liu B, Ji W, Ding J, Tao S, Lian F. Comparison of left atrial and left atrial appendage mechanics in the recurrence of atrial fibrillation after radiofrequency catheter ablation. Echocardiography. 2023;40(10):1048-1057. doi:10.1111/ECHO.15670
13. Saraçoglu E, Ural D, Kiliç S, Vuruskan E, Sahin T, Agir AA. Left atrial appendage 2D-strain assessed by transesophageal echocardiography is associated with thromboembolic risk in patients with atrial fibrillation. Turk Kardiyol Dern Ars. 2019;47(2):111-121. doi:10.5543/TKDA.2019.39482
14. Wang L, Fan J, Wang Z, Liao Y, Zhou B, Ma C. Evaluating left atrial appendage function in a subtype of non-valvular atrial fibrillation using transesophageal echocardiography combined with two-dimensional speckle tracking. Quant Imaging Med Surg. 2022;12(5):2721-2731. doi: 10.21037/QIMS-21-942/COIF)
15. Jankajova M, Kubikova L, Valocik G, et al. Left atrial appendage strain rate is associated with documented thromboembolism in nonvalvular atrial fibrillation. Wien Klin Wochenschr. 2019;131(7-8):156-164. doi:10. 1007/S00508-019-1469-6
16. Aytemir K, Özer N, Atalar E, et al. P-wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol. 2000;23(7):1109-1112. doi:10.1111/J.1540-8159.2000.TB00910.X
17. Liu P, Lv T, Yang Y, Gao Q, Zhang P. Use of P-wave indices to evaluate efficacy of catheter ablation and atrial fibrillation recurrence: a systematic review and meta-analysis. J Interv Card Electrophysiol. 2022; 65(3):827-840. doi:10.1007/S10840-022-01147-7
18. Escudero-Martínez I, Morales-Caba L, Segura T. Atrial fibrillation and stroke: a review and new insights. Trends Cardiovasc Med. 2023;33(1):23-29. doi:10.1016/J.TCM.2021.12.001
19. Zhang C, Kasner SE. Paroxysmal atrial fibrillation in cryptogenic stroke: an overlooked explanation? Curr Atheroscler Rep. 2015;17(12):66. doi:10.1007/S11883-015-0547-0
1. Van Gelder IC, Rienstra M, Bunting K V, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314-3414. doi:10.1093/EURHEARTJ/EHAE176
2. Imberti JF, Ding WY, Kotalczyk A, et al. Catheter ablation as first-line treatment for paroxysmal atrial fibrillation: a systematic review and meta-analysis. Heart. 2021;107(20):1630-1636. doi:10.1136/HEARTJNL- 2021-319496
3. Liu R, Li Y. Morphology and function assessment of left atrial appendage in patients with atrial fibrillation. Echocardiography. 2024;41(11):e70013. doi:10.1111/ECHO.70013
4. Muge A, Seda TK, Halil G, et al. Left atrial appendage orifice morphology in sickness and in health. Herz. 2025;50(3):185-191. doi:10.1007/S00059-024-05277-8
5. Su B, Sun SK, Dai XJ, Ma CS, Zhou BY. The novel left atrial appendage strain parameters are associated with thrombosis risk in patients with non-valvular atrial fibrillation. Echocardiography. 2023;40(6):483-493. doi:10.1111/echo.15578
6. Saberniak J, Skrebelyte-Strøm L, Orstad EB, et al. Left atrial appendage strain predicts subclinical atrial fibrillation in embolic strokes of undetermined source. Eur Heart J Open. 2023;3(3):oead039. doi:10.1093/ehjopen/oead039
7. Censi F, Corazza I, Reggiani E, et al. P-wave variability and atrial fibrillation. Sci Rep. 2016;6:26799. doi:10.1038/SREP26799
8. Pérez-Riera AR, de Abreu LC, Barbosa-Barros R, Grindler J, Fernandes-Cardoso A, Baranchuk A. P-wave dispersion: an update. Indian Pacing Electrophysiol J. 2016;16(4):126. doi:10.1016/J.IPEJ.2016.10.002
9. Baumgartner H, de Backer J, Babu-Narayan S V, et al. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2021;42(6):563-645. doi:10.1093/EURHEARTJ/EHAA554
10. Fatkin D, Kelly RP, Feneley MP. Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo. J Am Coll Cardiol. 1994;23(4):961-969. doi: 10.1016/0735-1097(94)90644-0
11. Elm E von, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806. doi:10.1136/BMJ.39335.541782.AD
12. Yang Y, Liu B, Ji W, Ding J, Tao S, Lian F. Comparison of left atrial and left atrial appendage mechanics in the recurrence of atrial fibrillation after radiofrequency catheter ablation. Echocardiography. 2023;40(10):1048-1057. doi:10.1111/ECHO.15670
13. Saraçoglu E, Ural D, Kiliç S, Vuruskan E, Sahin T, Agir AA. Left atrial appendage 2D-strain assessed by transesophageal echocardiography is associated with thromboembolic risk in patients with atrial fibrillation. Turk Kardiyol Dern Ars. 2019;47(2):111-121. doi:10.5543/TKDA.2019.39482
14. Wang L, Fan J, Wang Z, Liao Y, Zhou B, Ma C. Evaluating left atrial appendage function in a subtype of non-valvular atrial fibrillation using transesophageal echocardiography combined with two-dimensional speckle tracking. Quant Imaging Med Surg. 2022;12(5):2721-2731. doi: 10.21037/QIMS-21-942/COIF)
15. Jankajova M, Kubikova L, Valocik G, et al. Left atrial appendage strain rate is associated with documented thromboembolism in nonvalvular atrial fibrillation. Wien Klin Wochenschr. 2019;131(7-8):156-164. doi:10. 1007/S00508-019-1469-6
16. Aytemir K, Özer N, Atalar E, et al. P-wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol. 2000;23(7):1109-1112. doi:10.1111/J.1540-8159.2000.TB00910.X
17. Liu P, Lv T, Yang Y, Gao Q, Zhang P. Use of P-wave indices to evaluate efficacy of catheter ablation and atrial fibrillation recurrence: a systematic review and meta-analysis. J Interv Card Electrophysiol. 2022; 65(3):827-840. doi:10.1007/S10840-022-01147-7
18. Escudero-Martínez I, Morales-Caba L, Segura T. Atrial fibrillation and stroke: a review and new insights. Trends Cardiovasc Med. 2023;33(1):23-29. doi:10.1016/J.TCM.2021.12.001
19. Zhang C, Kasner SE. Paroxysmal atrial fibrillation in cryptogenic stroke: an overlooked explanation? Curr Atheroscler Rep. 2015;17(12):66. doi:10.1007/S11883-015-0547-0
1. Van Gelder IC, Rienstra M, Bunting K V, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314-3414. doi:10.1093/EURHEARTJ/EHAE176
2. Imberti JF, Ding WY, Kotalczyk A, et al. Catheter ablation as first-line treatment for paroxysmal atrial fibrillation: a systematic review and meta-analysis. Heart. 2021;107(20):1630-1636. doi:10.1136/HEARTJNL- 2021-319496
3. Liu R, Li Y. Morphology and function assessment of left atrial appendage in patients with atrial fibrillation. Echocardiography. 2024;41(11):e70013. doi:10.1111/ECHO.70013
4. Muge A, Seda TK, Halil G, et al. Left atrial appendage orifice morphology in sickness and in health. Herz. 2025;50(3):185-191. doi:10.1007/S00059-024-05277-8
5. Su B, Sun SK, Dai XJ, Ma CS, Zhou BY. The novel left atrial appendage strain parameters are associated with thrombosis risk in patients with non-valvular atrial fibrillation. Echocardiography. 2023;40(6):483-493. doi:10.1111/echo.15578
6. Saberniak J, Skrebelyte-Strøm L, Orstad EB, et al. Left atrial appendage strain predicts subclinical atrial fibrillation in embolic strokes of undetermined source. Eur Heart J Open. 2023;3(3):oead039. doi:10.1093/ehjopen/oead039
7. Censi F, Corazza I, Reggiani E, et al. P-wave variability and atrial fibrillation. Sci Rep. 2016;6:26799. doi:10.1038/SREP26799
8. Pérez-Riera AR, de Abreu LC, Barbosa-Barros R, Grindler J, Fernandes-Cardoso A, Baranchuk A. P-wave dispersion: an update. Indian Pacing Electrophysiol J. 2016;16(4):126. doi:10.1016/J.IPEJ.2016.10.002
9. Baumgartner H, de Backer J, Babu-Narayan S V, et al. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2021;42(6):563-645. doi:10.1093/EURHEARTJ/EHAA554
10. Fatkin D, Kelly RP, Feneley MP. Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo. J Am Coll Cardiol. 1994;23(4):961-969. doi: 10.1016/0735-1097(94)90644-0
11. Elm E von, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806. doi:10.1136/BMJ.39335.541782.AD
12. Yang Y, Liu B, Ji W, Ding J, Tao S, Lian F. Comparison of left atrial and left atrial appendage mechanics in the recurrence of atrial fibrillation after radiofrequency catheter ablation. Echocardiography. 2023;40(10):1048-1057. doi:10.1111/ECHO.15670
13. Saraçoglu E, Ural D, Kiliç S, Vuruskan E, Sahin T, Agir AA. Left atrial appendage 2D-strain assessed by transesophageal echocardiography is associated with thromboembolic risk in patients with atrial fibrillation. Turk Kardiyol Dern Ars. 2019;47(2):111-121. doi:10.5543/TKDA.2019.39482
14. Wang L, Fan J, Wang Z, Liao Y, Zhou B, Ma C. Evaluating left atrial appendage function in a subtype of non-valvular atrial fibrillation using transesophageal echocardiography combined with two-dimensional speckle tracking. Quant Imaging Med Surg. 2022;12(5):2721-2731. doi: 10.21037/QIMS-21-942/COIF)
15. Jankajova M, Kubikova L, Valocik G, et al. Left atrial appendage strain rate is associated with documented thromboembolism in nonvalvular atrial fibrillation. Wien Klin Wochenschr. 2019;131(7-8):156-164. doi:10. 1007/S00508-019-1469-6
16. Aytemir K, Özer N, Atalar E, et al. P-wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol. 2000;23(7):1109-1112. doi:10.1111/J.1540-8159.2000.TB00910.X
17. Liu P, Lv T, Yang Y, Gao Q, Zhang P. Use of P-wave indices to evaluate efficacy of catheter ablation and atrial fibrillation recurrence: a systematic review and meta-analysis. J Interv Card Electrophysiol. 2022; 65(3):827-840. doi:10.1007/S10840-022-01147-7
18. Escudero-Martínez I, Morales-Caba L, Segura T. Atrial fibrillation and stroke: a review and new insights. Trends Cardiovasc Med. 2023;33(1):23-29. doi:10.1016/J.TCM.2021.12.001
19. Zhang C, Kasner SE. Paroxysmal atrial fibrillation in cryptogenic stroke: an overlooked explanation? Curr Atheroscler Rep. 2015;17(12):66. doi:10.1007/S11883-015-0547-0
1. Van Gelder IC, Rienstra M, Bunting K V, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314-3414. doi:10.1093/EURHEARTJ/EHAE176
2. Imberti JF, Ding WY, Kotalczyk A, et al. Catheter ablation as first-line treatment for paroxysmal atrial fibrillation: a systematic review and meta-analysis. Heart. 2021;107(20):1630-1636. doi:10.1136/HEARTJNL- 2021-319496
3. Liu R, Li Y. Morphology and function assessment of left atrial appendage in patients with atrial fibrillation. Echocardiography. 2024;41(11):e70013. doi:10.1111/ECHO.70013
4. Muge A, Seda TK, Halil G, et al. Left atrial appendage orifice morphology in sickness and in health. Herz. 2025;50(3):185-191. doi:10.1007/S00059-024-05277-8
5. Su B, Sun SK, Dai XJ, Ma CS, Zhou BY. The novel left atrial appendage strain parameters are associated with thrombosis risk in patients with non-valvular atrial fibrillation. Echocardiography. 2023;40(6):483-493. doi:10.1111/echo.15578
6. Saberniak J, Skrebelyte-Strøm L, Orstad EB, et al. Left atrial appendage strain predicts subclinical atrial fibrillation in embolic strokes of undetermined source. Eur Heart J Open. 2023;3(3):oead039. doi:10.1093/ehjopen/oead039
7. Censi F, Corazza I, Reggiani E, et al. P-wave variability and atrial fibrillation. Sci Rep. 2016;6:26799. doi:10.1038/SREP26799
8. Pérez-Riera AR, de Abreu LC, Barbosa-Barros R, Grindler J, Fernandes-Cardoso A, Baranchuk A. P-wave dispersion: an update. Indian Pacing Electrophysiol J. 2016;16(4):126. doi:10.1016/J.IPEJ.2016.10.002
9. Baumgartner H, de Backer J, Babu-Narayan S V, et al. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2021;42(6):563-645. doi:10.1093/EURHEARTJ/EHAA554
10. Fatkin D, Kelly RP, Feneley MP. Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo. J Am Coll Cardiol. 1994;23(4):961-969. doi: 10.1016/0735-1097(94)90644-0
11. Elm E von, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806. doi:10.1136/BMJ.39335.541782.AD
12. Yang Y, Liu B, Ji W, Ding J, Tao S, Lian F. Comparison of left atrial and left atrial appendage mechanics in the recurrence of atrial fibrillation after radiofrequency catheter ablation. Echocardiography. 2023;40(10):1048-1057. doi:10.1111/ECHO.15670
13. Saraçoglu E, Ural D, Kiliç S, Vuruskan E, Sahin T, Agir AA. Left atrial appendage 2D-strain assessed by transesophageal echocardiography is associated with thromboembolic risk in patients with atrial fibrillation. Turk Kardiyol Dern Ars. 2019;47(2):111-121. doi:10.5543/TKDA.2019.39482
14. Wang L, Fan J, Wang Z, Liao Y, Zhou B, Ma C. Evaluating left atrial appendage function in a subtype of non-valvular atrial fibrillation using transesophageal echocardiography combined with two-dimensional speckle tracking. Quant Imaging Med Surg. 2022;12(5):2721-2731. doi: 10.21037/QIMS-21-942/COIF)
15. Jankajova M, Kubikova L, Valocik G, et al. Left atrial appendage strain rate is associated with documented thromboembolism in nonvalvular atrial fibrillation. Wien Klin Wochenschr. 2019;131(7-8):156-164. doi:10. 1007/S00508-019-1469-6
16. Aytemir K, Özer N, Atalar E, et al. P-wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol. 2000;23(7):1109-1112. doi:10.1111/J.1540-8159.2000.TB00910.X
17. Liu P, Lv T, Yang Y, Gao Q, Zhang P. Use of P-wave indices to evaluate efficacy of catheter ablation and atrial fibrillation recurrence: a systematic review and meta-analysis. J Interv Card Electrophysiol. 2022; 65(3):827-840. doi:10.1007/S10840-022-01147-7
18. Escudero-Martínez I, Morales-Caba L, Segura T. Atrial fibrillation and stroke: a review and new insights. Trends Cardiovasc Med. 2023;33(1):23-29. doi:10.1016/J.TCM.2021.12.001
19. Zhang C, Kasner SE. Paroxysmal atrial fibrillation in cryptogenic stroke: an overlooked explanation? Curr Atheroscler Rep. 2015;17(12):66. doi:10.1007/S11883-015-0547-0
1. Van Gelder IC, Rienstra M, Bunting K V, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314-3414. doi:10.1093/EURHEARTJ/EHAE176
2. Imberti JF, Ding WY, Kotalczyk A, et al. Catheter ablation as first-line treatment for paroxysmal atrial fibrillation: a systematic review and meta-analysis. Heart. 2021;107(20):1630-1636. doi:10.1136/HEARTJNL- 2021-319496
3. Liu R, Li Y. Morphology and function assessment of left atrial appendage in patients with atrial fibrillation. Echocardiography. 2024;41(11):e70013. doi:10.1111/ECHO.70013
4. Muge A, Seda TK, Halil G, et al. Left atrial appendage orifice morphology in sickness and in health. Herz. 2025;50(3):185-191. doi:10.1007/S00059-024-05277-8
5. Su B, Sun SK, Dai XJ, Ma CS, Zhou BY. The novel left atrial appendage strain parameters are associated with thrombosis risk in patients with non-valvular atrial fibrillation. Echocardiography. 2023;40(6):483-493. doi:10.1111/echo.15578
6. Saberniak J, Skrebelyte-Strøm L, Orstad EB, et al. Left atrial appendage strain predicts subclinical atrial fibrillation in embolic strokes of undetermined source. Eur Heart J Open. 2023;3(3):oead039. doi:10.1093/ehjopen/oead039
7. Censi F, Corazza I, Reggiani E, et al. P-wave variability and atrial fibrillation. Sci Rep. 2016;6:26799. doi:10.1038/SREP26799
8. Pérez-Riera AR, de Abreu LC, Barbosa-Barros R, Grindler J, Fernandes-Cardoso A, Baranchuk A. P-wave dispersion: an update. Indian Pacing Electrophysiol J. 2016;16(4):126. doi:10.1016/J.IPEJ.2016.10.002
9. Baumgartner H, de Backer J, Babu-Narayan S V, et al. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2021;42(6):563-645. doi:10.1093/EURHEARTJ/EHAA554
10. Fatkin D, Kelly RP, Feneley MP. Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo. J Am Coll Cardiol. 1994;23(4):961-969. doi: 10.1016/0735-1097(94)90644-0
11. Elm E von, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806. doi:10.1136/BMJ.39335.541782.AD
12. Yang Y, Liu B, Ji W, Ding J, Tao S, Lian F. Comparison of left atrial and left atrial appendage mechanics in the recurrence of atrial fibrillation after radiofrequency catheter ablation. Echocardiography. 2023;40(10):1048-1057. doi:10.1111/ECHO.15670
13. Saraçoglu E, Ural D, Kiliç S, Vuruskan E, Sahin T, Agir AA. Left atrial appendage 2D-strain assessed by transesophageal echocardiography is associated with thromboembolic risk in patients with atrial fibrillation. Turk Kardiyol Dern Ars. 2019;47(2):111-121. doi:10.5543/TKDA.2019.39482
14. Wang L, Fan J, Wang Z, Liao Y, Zhou B, Ma C. Evaluating left atrial appendage function in a subtype of non-valvular atrial fibrillation using transesophageal echocardiography combined with two-dimensional speckle tracking. Quant Imaging Med Surg. 2022;12(5):2721-2731. doi: 10.21037/QIMS-21-942/COIF)
15. Jankajova M, Kubikova L, Valocik G, et al. Left atrial appendage strain rate is associated with documented thromboembolism in nonvalvular atrial fibrillation. Wien Klin Wochenschr. 2019;131(7-8):156-164. doi:10. 1007/S00508-019-1469-6
16. Aytemir K, Özer N, Atalar E, et al. P-wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol. 2000;23(7):1109-1112. doi:10.1111/J.1540-8159.2000.TB00910.X
17. Liu P, Lv T, Yang Y, Gao Q, Zhang P. Use of P-wave indices to evaluate efficacy of catheter ablation and atrial fibrillation recurrence: a systematic review and meta-analysis. J Interv Card Electrophysiol. 2022; 65(3):827-840. doi:10.1007/S10840-022-01147-7
18. Escudero-Martínez I, Morales-Caba L, Segura T. Atrial fibrillation and stroke: a review and new insights. Trends Cardiovasc Med. 2023;33(1):23-29. doi:10.1016/J.TCM.2021.12.001
19. Zhang C, Kasner SE. Paroxysmal atrial fibrillation in cryptogenic stroke: an overlooked explanation? Curr Atheroscler Rep. 2015;17(12):66. doi:10.1007/S11883-015-0547-0
1. Van Gelder IC, Rienstra M, Bunting K V, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314-3414. doi:10.1093/EURHEARTJ/EHAE176
2. Imberti JF, Ding WY, Kotalczyk A, et al. Catheter ablation as first-line treatment for paroxysmal atrial fibrillation: a systematic review and meta-analysis. Heart. 2021;107(20):1630-1636. doi:10.1136/HEARTJNL- 2021-319496
3. Liu R, Li Y. Morphology and function assessment of left atrial appendage in patients with atrial fibrillation. Echocardiography. 2024;41(11):e70013. doi:10.1111/ECHO.70013
4. Muge A, Seda TK, Halil G, et al. Left atrial appendage orifice morphology in sickness and in health. Herz. 2025;50(3):185-191. doi:10.1007/S00059-024-05277-8
5. Su B, Sun SK, Dai XJ, Ma CS, Zhou BY. The novel left atrial appendage strain parameters are associated with thrombosis risk in patients with non-valvular atrial fibrillation. Echocardiography. 2023;40(6):483-493. doi:10.1111/echo.15578
6. Saberniak J, Skrebelyte-Strøm L, Orstad EB, et al. Left atrial appendage strain predicts subclinical atrial fibrillation in embolic strokes of undetermined source. Eur Heart J Open. 2023;3(3):oead039. doi:10.1093/ehjopen/oead039
7. Censi F, Corazza I, Reggiani E, et al. P-wave variability and atrial fibrillation. Sci Rep. 2016;6:26799. doi:10.1038/SREP26799
8. Pérez-Riera AR, de Abreu LC, Barbosa-Barros R, Grindler J, Fernandes-Cardoso A, Baranchuk A. P-wave dispersion: an update. Indian Pacing Electrophysiol J. 2016;16(4):126. doi:10.1016/J.IPEJ.2016.10.002
9. Baumgartner H, de Backer J, Babu-Narayan S V, et al. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2021;42(6):563-645. doi:10.1093/EURHEARTJ/EHAA554
10. Fatkin D, Kelly RP, Feneley MP. Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo. J Am Coll Cardiol. 1994;23(4):961-969. doi: 10.1016/0735-1097(94)90644-0
11. Elm E von, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806. doi:10.1136/BMJ.39335.541782.AD
12. Yang Y, Liu B, Ji W, Ding J, Tao S, Lian F. Comparison of left atrial and left atrial appendage mechanics in the recurrence of atrial fibrillation after radiofrequency catheter ablation. Echocardiography. 2023;40(10):1048-1057. doi:10.1111/ECHO.15670
13. Saraçoglu E, Ural D, Kiliç S, Vuruskan E, Sahin T, Agir AA. Left atrial appendage 2D-strain assessed by transesophageal echocardiography is associated with thromboembolic risk in patients with atrial fibrillation. Turk Kardiyol Dern Ars. 2019;47(2):111-121. doi:10.5543/TKDA.2019.39482
14. Wang L, Fan J, Wang Z, Liao Y, Zhou B, Ma C. Evaluating left atrial appendage function in a subtype of non-valvular atrial fibrillation using transesophageal echocardiography combined with two-dimensional speckle tracking. Quant Imaging Med Surg. 2022;12(5):2721-2731. doi: 10.21037/QIMS-21-942/COIF)
15. Jankajova M, Kubikova L, Valocik G, et al. Left atrial appendage strain rate is associated with documented thromboembolism in nonvalvular atrial fibrillation. Wien Klin Wochenschr. 2019;131(7-8):156-164. doi:10. 1007/S00508-019-1469-6
16. Aytemir K, Özer N, Atalar E, et al. P-wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol. 2000;23(7):1109-1112. doi:10.1111/J.1540-8159.2000.TB00910.X
17. Liu P, Lv T, Yang Y, Gao Q, Zhang P. Use of P-wave indices to evaluate efficacy of catheter ablation and atrial fibrillation recurrence: a systematic review and meta-analysis. J Interv Card Electrophysiol. 2022; 65(3):827-840. doi:10.1007/S10840-022-01147-7
18. Escudero-Martínez I, Morales-Caba L, Segura T. Atrial fibrillation and stroke: a review and new insights. Trends Cardiovasc Med. 2023;33(1):23-29. doi:10.1016/J.TCM.2021.12.001
19. Zhang C, Kasner SE. Paroxysmal atrial fibrillation in cryptogenic stroke: an overlooked explanation? Curr Atheroscler Rep. 2015;17(12):66. doi:10.1007/S11883-015-0547-0
1. Van Gelder IC, Rienstra M, Bunting K V, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314-3414. doi:10.1093/EURHEARTJ/EHAE176
2. Imberti JF, Ding WY, Kotalczyk A, et al. Catheter ablation as first-line treatment for paroxysmal atrial fibrillation: a systematic review and meta-analysis. Heart. 2021;107(20):1630-1636. doi:10.1136/HEARTJNL- 2021-319496
3. Liu R, Li Y. Morphology and function assessment of left atrial appendage in patients with atrial fibrillation. Echocardiography. 2024;41(11):e70013. doi:10.1111/ECHO.70013
4. Muge A, Seda TK, Halil G, et al. Left atrial appendage orifice morphology in sickness and in health. Herz. 2025;50(3):185-191. doi:10.1007/S00059-024-05277-8
5. Su B, Sun SK, Dai XJ, Ma CS, Zhou BY. The novel left atrial appendage strain parameters are associated with thrombosis risk in patients with non-valvular atrial fibrillation. Echocardiography. 2023;40(6):483-493. doi:10.1111/echo.15578
6. Saberniak J, Skrebelyte-Strøm L, Orstad EB, et al. Left atrial appendage strain predicts subclinical atrial fibrillation in embolic strokes of undetermined source. Eur Heart J Open. 2023;3(3):oead039. doi:10.1093/ehjopen/oead039
7. Censi F, Corazza I, Reggiani E, et al. P-wave variability and atrial fibrillation. Sci Rep. 2016;6:26799. doi:10.1038/SREP26799
8. Pérez-Riera AR, de Abreu LC, Barbosa-Barros R, Grindler J, Fernandes-Cardoso A, Baranchuk A. P-wave dispersion: an update. Indian Pacing Electrophysiol J. 2016;16(4):126. doi:10.1016/J.IPEJ.2016.10.002
9. Baumgartner H, de Backer J, Babu-Narayan S V, et al. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2021;42(6):563-645. doi:10.1093/EURHEARTJ/EHAA554
10. Fatkin D, Kelly RP, Feneley MP. Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo. J Am Coll Cardiol. 1994;23(4):961-969. doi: 10.1016/0735-1097(94)90644-0
11. Elm E von, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806. doi:10.1136/BMJ.39335.541782.AD
12. Yang Y, Liu B, Ji W, Ding J, Tao S, Lian F. Comparison of left atrial and left atrial appendage mechanics in the recurrence of atrial fibrillation after radiofrequency catheter ablation. Echocardiography. 2023;40(10):1048-1057. doi:10.1111/ECHO.15670
13. Saraçoglu E, Ural D, Kiliç S, Vuruskan E, Sahin T, Agir AA. Left atrial appendage 2D-strain assessed by transesophageal echocardiography is associated with thromboembolic risk in patients with atrial fibrillation. Turk Kardiyol Dern Ars. 2019;47(2):111-121. doi:10.5543/TKDA.2019.39482
14. Wang L, Fan J, Wang Z, Liao Y, Zhou B, Ma C. Evaluating left atrial appendage function in a subtype of non-valvular atrial fibrillation using transesophageal echocardiography combined with two-dimensional speckle tracking. Quant Imaging Med Surg. 2022;12(5):2721-2731. doi: 10.21037/QIMS-21-942/COIF)
15. Jankajova M, Kubikova L, Valocik G, et al. Left atrial appendage strain rate is associated with documented thromboembolism in nonvalvular atrial fibrillation. Wien Klin Wochenschr. 2019;131(7-8):156-164. doi:10. 1007/S00508-019-1469-6
16. Aytemir K, Özer N, Atalar E, et al. P-wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol. 2000;23(7):1109-1112. doi:10.1111/J.1540-8159.2000.TB00910.X
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Article available in :
Volume 6, Issue 3, 2025
Page : 199-206
https://doi.org/10.47582/jompac.1652473
Article Information
Received : 06 Mar 2025
Accepted : 20 Nis 2025
Published : 18 Haz 2025
Corresponding Author :

Ayşe İrem Demirtola Mammadli: Department of Cardiology, Ankara Bilkent City Hospital, Ankara, Turkiye

[email protected]
Citation : Demirtola Aİ, İnan D, Mammadli A, et al. Sol atriyal apendiks straini ve P dalga dispersiyonu: paroksismal atriyal fibrilasyonun elektro-mekanik belirteçleri. J Med Palliat Care. 2025;6(3):199-206. doi:10.47582/jompac.1652473

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