Pulse Wave Velocity in Atrial Fibrillation: A Scoping Review of Clinical Relevance

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with high morbidity, mortality, and healthcare burden. Arterial stiffness (AS) alters cardiac loading conditions and contributes to ventricular arterial uncoupling (VAC), diastolic dysfunction, and atrial remodeling. Pulse wave velocity (PWV) is the standard noninvasive measure of AS, but its role across the spectrum of AF has not been clearly defined. This scoping review assessed the existing literature on PWV and AF, with attention to disease onset, clinical characteristics, progression, treatment response, and outcomes. A scoping review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA ScR) guidelines. The databases of MEDLINE, EMBASE, Web of Science, and CINAHL were searched for studies published between 2014 and 2024. Eligible studies included adult human populations with AF and reporting of at least one PWV measurement. Systematic reviews, meta-analyses, case reports, animal studies, and abstract-only publications were excluded. Study selection and data extraction were performed independently by multiple reviewers, and 26 studies met the inclusion criteria. Most studies reported an association between higher PWV and AF, particularly in relation to atrial remodeling, adverse clinical outcomes, and postoperative AF. Central measures of AS showed more consistent associations than peripheral indices. Evidence for PWV as a predictor of new-onset AF was mixed after adjustment for traditional risk factors. Several studies suggested greater clinical relevance in patients with established AF, where higher PWV was linked to worse outcomes and increased disease burden. Measurement methods and study populations varied substantially. Overall, the current evidence supports a meaningful relationship between AS and AF. Pulse wave velocity appears most informative as a marker of disease severity, hemodynamic stress, and clinical prognosis rather than as a standalone predictor of AF onset. Differences in PWV methodology and study design limit cross-study comparability and causal inference. Future longitudinal studies using standardized, AF-specific PWV protocols should test whether PWV improves prognostic stratification, perioperative risk assessment, and population-level prediction of AF onset.