Prediction of New Onset Atrial Fibrillation Through P Wave Analysis in 12 Lead ECG

Abstract

SummaryIt is unknown whether 12-lead ECG can predict new-onset AF. In the present study, we identified patients with new onset AF from our digitally stored ECG database, and the P wave morphologies were analyzed in their preceding sinus rhythm recordings as the precursor state for AF. The P wave was analyzed in the most recent ECG recording of sinus rhythm preceding new onset AF within 12 months. The duration and amplitude of P waves were analyzed in 12 leads and compared between the 2 groups with the other clinical parameters. The study population consisted of 68 patients with new-onset AF and 68 age and sex-matched controls. Multivariate analysis revealed that the P wave amplitude in leads II and V 1 (0.157 ± 0.056 versus 0.115 ± 0.057 mV, P = 0.032, and 0.146 ± 0.089 versus 0.095 ± 0.036 mV, P = 0.002) and P wave dispersion (56.9 ± 14.8 versus 33.5 ± 12.9 ms, P = 0.001) were significant independent factors for the prediction of new-onset AF. By using these factors, new-onset AF could be predicted with a sensitivity of 69.1% and specificity of 88.2%. P wave analysis is useful for predicting new onset AF. (Int Heart J 2014; 55: 422-427) Key words: P wave dispersion, P wave duration, Atrial remodeling A lthough several experimental studies predicted a preventive effect of upstream therapies for atrial fibrillation (AF) using angiotensin receptor blockades (ARBs), 1,2) recent clinical trials of such upstream therapies have failed to demonstrate their preventive effect in clinical cases. The reason for this discrepancy is unclear; however, it may be partly explained by the heterogeneity of the pathogenic conditions of AF in clinical cases.3,4) Because a meta-analysis of ARB studies 2) has suggested a possible effect of ARB in the prevention of new-onset AF in clinical cases, upstream therapy may possibly exhibit an effect if it could be performed in the precursor state of AF. Even when considering catheter ablation for AF, it is important to detect the early or precursor state of AF in clinical cases because the effect of catheter ablation is higher in patients with earlier-stage AF, even in those with simple circumference ablation of pulmonary veins.5-7) The arrhythmogenic substrate of AF is known to be constructed progressively under various pathological conditions, including AF itself; 7-11) therefore, it could be speculated that the electrophysiological properties of the atrium may be modified in its precursor state. Several studies have attempted to identify the changes in P waves during sinus rhythm in AF patients. 7,8,[12][13][14][15][16] In these reports, prolongation of the P wave duration or expansion of the dispersion of the P wave duration in the surface 12-lead electrocardiogram (ECG) have been focused on as indices for identification of AF patients. [10][11][12][13][14][15] In the present study, we retrospectively identified patients with new-onset AF in the digital ECG profiling system of our hospital, and P waves in the preceding sinus rhythm state were analyzed as the precursor state for new-on...

Left Atrial Remodeling Assessed by Transthoracic Echocardiography Predicts Left Atrial Appendage Flow Velocity in Patients With Paroxysmal Atrial Fibrillation

“…15,[22][23][24][25] Increased interstitial fibrosis may explain inter-atrial conduction disturbances. 26) Mizuno, et al previously reported that inter-atrial conduction time determined using TTE and ECG was delayed in patients with progressive systemic sclerosis.…”

Discrimination of Paroxysmal and Persistent Atrial Fibrillation in Patients With New-Onset Atrial Fibrillation

“…In the consideration of single and same P wave vector in the ECG recording, some investigators have doubted the clinical usefulness of this dispersion, but our present and preceding studies and other investigators have stated that the P wave dispersion is a useful index with which to evaluate atrial electrophysiology. 6,11,12,[14][15][16]19) Because P wave dispersion is the relative parameter calculated from the other measurements, correction or adaptation of direct value by P wave duration or heart rate might be a possible method to obtain a parameter with absolute meaning, but because we could not find such a trial about correction in dispersion in the previous reports, we just used direct data of dispersion in this study. The mechanism underlying P wave dispersion change remains uncertain, but may partially be explained by the change in direction of the atrial activation vector.…”

“…This activation may be recorded in some leads, but is likely to not be detected in leads with a horizontal angle to the direction of vector. 6,16,26) This phenomenon may result in the pseudo-disappearance of the terminal portion of the P wave in some leads, resulting in the enlargement of P wave dispersion in all 12 leads. In the present study, P wave duration also tended to be longer in persistent AF patients than in PAF patients, but the difference was not significant.…”

“…4,5) Recently, we have reported that P wave analysis in the 12-lead ECG of sinus rhythm is useful in determining the emergence of AF in clinical cases. 6) We have shown that the P wave amplitude in lead II or V1 was higher, and P wave dispersion, ie, the dispersion of P wave duration, was larger in patients with new-onset AF compared with control patients without AF.6) Therefore, we hypothesized that the clinical stage of AF may also be identified by P wave analysis, as well as with the other clinical parameters. In the present study, we retrospectively identified patients with new-onset AF in the digital ECG profiling system of our hospital.…”

KCNN3 SNP rs13376333 on Chromosome 1q21 Confers Increased Risk of Atrial Fibrillation

“…Over the past few years, it has been reported that P wave analysis in 12-lead electrocardiograms (ECG) can be useful for predicting new onset AF, 3) and genetic predisposition is the newest addition to the occurrence of structural or lone AF. Some AF specific genes found may contribute to the development of left atrium remodeling, 4) and several genetic loci have been identified for monogenetic AF, such as loci on chromosomes 1q21, 3p21, 11p15.5, 12p13, 21q22, 7q35-36, and 6q14- 16.…”