Relation of Electrocardiographic Left Atrial Abnormalities to Risk of Stroke in Patients with Atrial Fibrillation.

The P-wave terminal force in lead V (PTFV) on the 12-lead electrocardiogram (ECG) quantifies left atrial (LA) structural and electrophysiologic abnormalities. We aimed to evaluate the association between PTFV and cerebrovascular accident (CVA) as well as LA structure and function in patients with atrial fibrillation (AF). We conducted a cross-sectional study of 229 patients with AF (60 ± 10years, 72% men) with (n = 21) and without (n = 208) a history of CVA, who underwent preablation ECG and cardiac magnetic resonance in sinus rhythm. PTFV was defined as the duration (in milliseconds) of the downward deflection of the P wave in lead V multiplied by the absolute value of its amplitude (in microvolts) on ECG. PTFV is associated with LA minimum volume (V) and left ventricular ejection fraction but not associated with the extent of LA fibrosis quantified by cardiac magnetic resonance late gadolinium enhancement. In addition, PTFV is associated with CVA independent of the CHADS-VASc score and LA V (odds ratio 1.23; 95% confidence interval 1.08 to 1.40; p = 0.002). Furthermore, PTFV has an incremental value over the CHADS-VASc score as a marker of CVA (p <0.001). In conclusion, ECG-defined PTFV is independent marker of stroke in patients with AF and reflects the underlying LA remodeling. Our findings suggest that evaluation of PTFV can improve the current risk stratification of stroke.