ArticleJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2026
Clinical significance of presystolic wave attenuation in patients with paroxysmal atrial fibrillation.
Article in Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe presystolic wave (PSW), a late-diastolic Doppler flow signal in the left ventricular outflow tract, reflects atrial contraction and atrioventricular coupling. Although its presence is considered a physiological finding in healthy individuals, alterations in PSW characteristics may indicate impaired atrial or ventricular compliance. This study aimed to evaluate the relationship between PSW and cerebrovascular events (CVE) in patients with paroxysmal atrial fibrillation (PAF).
methodsIn this retrospective study, 380 patients diagnosed with PAF by 24-hour Holter monitoring between January 2019 and January 2025 were analyzed. Transthoracic echocardiography was performed to assess PSW presence, left ventricular systolic and diastolic functions. Patients were divided according to PSW presence and history of CVE (stroke or transient ischemic attack). Clinical, laboratory, and echocardiographic variables were compared, and multivariate logistic regression was used to identify independent predictors of CVE.
resultsPSW was identified in 284 (74.7%) patients. Those without PSW were older, had greater left atrial volume index (LAVI) and left ventricular mass index (LVMI), and more frequently had previous CVE (45.8% vs. 16.9%, p < 0.001). In multivariate analysis, high CHA₂DS₂-VASc score, increased LAVI, and absence of PSW were independent predictors of CVE. ROC analysis showed that a PSW peak velocity < 0.30 m/s was associated with the presence of CVE, with 81% sensitivity and 67% specificity (AUC = 0.783, p < 0.001).
conclusionAbsence or reduction of the PSW is independently associated with CVE in PAF patients. PSW assessment provides a simple, reproducible, and noninvasive measure of atrioventricular mechanical function that may be associated with increased thromboembolic vulnerability.
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