Aims: Atrial cardiomyopathy (AtCM) is associated with new-onset atrial fibrillation, arrhythmia recurrence after pulmonary vein isolation, and ischemic stroke. The amplified P-wave duration (APWD) as surrogate marker for invasively measured atrial activation time offers a promising non-invasive, cost-effective tool to diagnose AtCM. However, despite high sensitivity and specificity, APWD remains limited in clinical practice due to challenging P-wave offset detection in some patients. We hypothesize that electrodes closer to the atria yield P-waves with early on-, late offset and clearer delineation, enabling APWD measurement more accurately compared to the conventional 12-lead ECG.
Methods: Body surface potential maps were simulated using 100 atrial and 25 torso geometries derived from statistical shape models, combined with 21 fibrosis distributions derived from electroanatomical voltage mapping. Unipolar setups (right-leg and Wilson's central terminal references) were optimized by identifying anterior and posterior positions with high P-wave amplitude and clearly defined early on- and late offsets.
Results and Conclusion: The optimized positions were located above the conventional V1/V2 electrodes and align with previous studies to improve standard P-wave recording. In conclusion, this work demonstrates that optimized electrode placement could improve APWD measurement, thereby enhancing AtCM diagnosis.