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

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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