Left atrial appendage strain and P-wave dispersion: electro-mechanical markers of paroxysmal atrial fibrillation

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