Evaluation of electrocardiographic P wave parameters in predicting long-term atrial fibrillation in patients with acute ischemic stroke

Abstract

Background Electrocardiographic parameters, such as P wave peak time (PWPT), P wave duration (PWD), and P wave amplitude in lead DI, have been utilized to assess left atrial anomalies linked to the development of atrial fibrillation (AF) in different cohort settings.

Objective To compare electrocardiographic parameters, such as P waves, in predicting long-term AF risk in acute ischemic stroke cases.

Methods The data of 231 consecutive acute ischemic stroke cases were retrospectively collected. Two independent cardiologists interpreted the electrocardiography recordings for PWPT, PWD, and P wave amplitude in lead DI. The median follow-up study period was 16 (interquartile range [IQR]: 11–24) months.

Results In total, AF was detected in 43 (18.6%) cases. All studied P wave parameters were found to be statistically significant in cases with AF. Based on multivariable logistic regression analysis, dementia, left atrium volume index, PWD (razão de chances [RC]: 1.11; 95% confidence interval [CI]: 1.058–1.184; p = 0.003), PWPT in lead DII (RC: 1.030; 95%CI: 1.010–1.050; p = 0.003), and advanced interatrial block morphology were independent predictors of long-term AF. P wave duration had the highest area under the curve value, sensitivity, and specificity for long-term AF in such cases compared with the other P wave parameters.

Conclusions Our head-to-head comparison of well-known P wave parameters demonstrated that PWD might be the most useful P wave parameter for long-term AF in acute ischemic stroke cases.

Resumo

Antecedentes Parâmetros eletrocardiográficos, como tempo de pico da onda P (PWPT, na sigla em inglês), duração da onda P (PWD, na sigla em inglês) e amplitude da onda P na derivação DI, têm sido utilizados para avaliar anomalias atriais esquerdas ligadas ao desenvolvimento de fibrilação atrial (FA) em diferentes cenários de coortes.

Objetivo Comparar os parâmetros eletrocardiográficos destas ondas P na predição do risco de FA de longo prazo em casos de acidente vascular cerebral (AVC) isquêmico agudo.

Métodos Os dados de 231 casos consecutivos de AVC isquêmico agudo foram coletados retrospectivamente. Dois cardiologistas independentes interpretaram os registros eletrocardiográficos para PWPT, PWD e amplitude da onda P na derivação DI. O período médio do estudo de acompanhamento foi de 16 (intervalo interquartil [IQR, na sigla em inglês]: 11–24) meses.

Resultados No total, FA foi detectada em 43 (18,6%) casos. Todos os parâmetros da onda P estudados foram considerados estatisticamente significativos nos casos com FA. Com base na análise de regressão logística multivariável, demência, índice de volume do átrio esquerdo, PWD (razão de chances [RC]: 1,112; intervalo de confiança [IC] 95%: 1,058–1,184; p = 0,003), PWPT na derivação DII (RC: 1,030; IC95%: 1,010–1,050; p = 0,003) e avançada morfologia do bloqueio interatrial foram preditores independentes de FA de longo prazo. A PWD teve a maior área sob o valor da curva, sensibilidade e especificidade para FA de longo prazo em tais casos em comparação com os outros parâmetros da onda P.

Conclusões Nossa comparação direta de parâmetros da onda P bem conhecidos demonstrou que a PWD pode ser o parâmetro da onda P mais útil para FA de longa duração em casos de AVC isquêmico agudo.

Keywords

p Wave - Reference Parameters - Electrocardiography - Ischemic Stroke

Palavras-chave

Onda p - Parâmetros de Referência Eletrocardiografia - AVC Isquêmico

Authors' Contributions

TÇ, MIH: conception; TÇ, MIH, MS, GÇ: design; MMA, ALO: supervision; SA, SD: fundings; MS, GÇ, VÇ, SA, SK, SD: materials; TÇ, MS, GÇ, VÇ, SA, SK, SD: data collection; MİH: analysis; TÇ, SA: literature review; TÇ: writer; All authors: critical review.

Publication History

Received: 27 August 2021

Accepted: 16 October 2021

Article published online:
09 November 2022

• References

• 1 Kuriakose D, Xiao Z. Pathophysiology and Treatment of Stroke: Present Status and Future Perspectives. Int J Mol Sci 2020; 21 (20) 7609 DOI: 10.3390/ijms21207609.
• 2 Jickling GC, Xu H, Stamova B. et al. Signatures of cardioembolic and large-vessel ischemic stroke. Ann Neurol 2010; 68 (05) 681-692 DOI: 10.1002/ana.22187.
• 3 Sutamnartpong P, Dharmasaroja PA, Ratanakorn D, Arunakul I. Atrial fibrillation and paroxysmal atrial fibrillation detection in patients with acute ischemic stroke. J Stroke Cerebrovasc Dis 2014; 23 (05) 1138-1141 DOI: 10.1016/j.jstrokecerebrovasdis.2013.09.032.
• 4 Hindricks G, Potpara T, Dagres N. et al; ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42 (05) 373-498 DOI: 10.1093/eurheartj/ehaa612.
• 5 He J, Tse G, Korantzopoulos P. et al. P-Wave Indices and Risk of Ischemic Stroke: A Systematic Review and Meta-Analysis. Stroke 2017; 48 (08) 2066-2072 DOI: 10.1161/STROKEAHA.117.017293.
• 6 Park JK, Park J, Uhm JS, Joung B, Lee MH, Pak HN. Low P-wave amplitude (<0.1 mV) in lead I is associated with displaced inter-atrial conduction and clinical recurrence of paroxysmal atrial fibrillation after radiofrequency catheter ablation. Europace 2016; 18 (03) 384-391 DOI: 10.1093/europace/euv028.
• 7 Shturman A, Bickel A, Atar S. The predictive value of P-wave duration by signal-averaged electrocardiogram in acute ST elevation myocardial infarction. Isr Med Assoc J 2012; 14 (08) 493-497
• 8 Sajeev JK, Koshy AN, Dewey H. et al. Poor reliability of P-wave terminal force V₁ in ischemic stroke. J Electrocardiol 2019; 52: 47-52 DOI: 10.1016/j.jelectrocard.2018.11.007.
• 9 Yıldırım E, Günay N, Bayam E, Keskin M, Ozturkeri B, Selcuk M. Relationship between paroxysmal atrial fibrillation and a novel electrocardiographic parameter P wave peak time. J Electrocardiol 2019; 57: 81-86 DOI: 10.1016/j.jelectrocard.2019.09.006.
• 10 Burak C, Yesin M, Tanık VO. et al. Prolonged P wave peak time is associated with the severity of coronary artery disease in patients with non-ST segment elevation myocardial infarction. J Electrocardiol 2019; 55: 138-143 DOI: 10.1016/j.jelectrocard.2019.05.015.
• 11 Kamel H, Healey JS. Cardioembolic Stroke. Circ Res. 2017; 120: 514–526. Kamel H, Healey JS. Cardioembolic Stroke. Circ Res 2017; 120 (03) 514-526 DOI: 10.1161/CIRCRESAHA.116.308407.
• 12 Hylek EM, Go AS, Chang Y. et al. Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation. N Engl J Med 2003; 349 (11) 1019-1026 DOI: 10.1056/NEJMoa022913.
• 13 Cokkinos DV, Leachman RD, Zamalloa O, Cabrera R, Ferrer MI. Influence of atrial mass on amplitude and duration of the P wave. Chest 1972; 61 (04) 336-339 DOI: 10.1378/chest.61.4.336.
• 14 Kocer A, Barutcu I, Atakay S, Ozdemirli B, Gul L, Karakaya O. P wave duration changes and dispersion. A risk factor or autonomic dysfunction in stroke?. Neurosciences (Riyadh) 2009; 14 (01) 14-18
• 15 Hayashi H, Miyamoto A, Kawaguchi T. et al. P-pulmonale and the development of atrial fibrillation. Circ J 2014; 78 (02) 329-337 DOI: 10.1253/circj.cj-13-0654.
• 16 Gorenek B, Birdane A, Kudaiberdieva G. et al. P wave amplitude and duration may predict immediate recurrence of atrial fibrillation after internal cardioversion. Ann Noninvasive Electrocardiol 2003; 8 (03) 215-218 DOI: 10.1046/j.1542-474x.2003.08308.x.
• 17 Alexander B, Haseeb S, van Rooy H. et al. Reduced P-wave Voltage in Lead I is Associated with Development of Atrial Fibrillation in Patients with Coronary Artery Disease. J Atr Fibrillation 2017; 10 (04) 1657 DOI: 10.4022/jafib.1657.