Prolonged atrial electromechanical delay and P-wave parameters in asymptomatic carotid artery stenosis: novel insights from a non-invasive evaluation

Authors : Faruk Serhatlıoğlu, Şaban Keleşoğlu

Pages : 20-26

Doi:10.47582/jompac.1592028

View : 49 | Download : 55

Publication Date : 2025-02-14

Article Type : Research Paper

Abstract :Aims: Stroke is one of the top three causes of death in developed societies. Ischemic strokes are linked to carotid artery stenosis (CAS). Atrial fibrillation (AF) is a commonly encountered clinical arrhythmia. It has been shown that the prolongation of intra- and interatrial conduction times, known as atrial electromechanical delay (EMD), is associated with a higher risk of AF. We aimed to determine the correlation of atrial conduction abnormalities between surface electrocardiographic and TDI measurements in the CAS patient group. Methods: The study included 76 patients diagnosed with extracranial internal carotid artery (ICA) stenosis. Asymptomatic severe CAS was defined as patients with 70-99% stenosis detected by carotid digital subtraction angiography (DSA). The longest P-wave and the longest atrial conduction time ACT were considered as the maximal P-wave duration. The difference between the longest P-wave (Pmax) and the shortest P-wave (Pmin) was accepted as PD. (PD=Pmax-Pmin). Atrial EMD was defined as the time interval from the onset of atrial electrical activity to the beginning of mechanical atrial contraction. Results: The CAS group had significantly longer Pmax and PD values compared to the control group (Pmax 104.72±6.03 and 93.06±7.26 ms, p<0.001; PD 48.55±6.72 and 38.50±8.12 ms, p<0.001). In the TDI examination, the atrial EMD parameters (PA lateral, PA septum) were significantly longer in the CAS group compared to the control group. (77.88±5.13 vs 65.53±9.11 ms; p<0.0001; 63.77±3.95 vs 54.56±7.13 ms; p<0.001 respectively) Both interatrial and intra-atrial EMD times were found to be longer in the CAS group compared to the control group (31.72±7.39 vs 22.13±8.67 ms; p<0.001; 17.61±7.76 vs 11.16±7.76 vs 11.16±7.04 ms; p<0.001, respectively). In the correlation analysis, a positive relationship was found between interatrial and interatrial EMD and Pmax and PD (p<0.001, both). Conclusion: We found that both intra-atrial and inter-atrial electromechanical conduction times were longer in CAS patients. This suggests that CAS patients are at risk for AF in their follow-up.
Keywords : Karotid arter stenozu, atriyal fibrilasyon, atriyal iletim süresi

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