Atrial electromechanical coupling parameters after transcatheter aortic valve replacement

The article entitled Effect of transcatheter aortic valve replacement on P-wave duration, P-wave dispersion and left atrial size by Dursun, et al. has contributed to our knowledge regarding the positive effects of transcatheter aortic valve replacement (TAVR) procedure on atrial electrical remodeling. In this study, TAVR procedure led to a decrease on P-wave duration and P-wave dispersion.  As expected, severe aortic valve stenosis causes to left ventricular remodeling due to chronic pressure load, so TAVR helps myocardium to regain its homogeneity. This happens by reduced after load, improvements in myocardial strain and thus left heart functions. Previous studies have shown that, TAVR procedure had some positive effects on ventricular heterogeneity. QT dispersion was reduced after TAVR and ventricular myocardium was supposed to be more homogenous. As a natural result, atrial structure and function are expected to be improved after TAVR. In this respect, the study by Dursun, et al. presented an improvement in P-wave duration and P-wave dispersion after TAVR procedure. However, we have some concerns about methodological perspective. First of all, the authors have measured the P-wave duration and P-wave dispersion manually. It would have been better if the authors had transferred ECG recordings to the digital platform in order to obtain more accurate data. Moreover, P-wave duration and P-wave dispersion have some technical problems in the measurements, especially with high rates of intraand inter-observer variabilities. As a relatively new tool to evaluate the electrical heterogeneity of the atria, atrial electromechanical coupling (EMC) parameters may be measured using echocardiography. Increased EMC parameters