P-272 Prolonged P-wave duration on the 65-lead ECG in heart failure patients: Effect of atrial electrical remodeling — heralding atrial fibrillation?

Abstract Background Advanced interatrial block (IAB), prolonged and bimodal P waves in surface ECG inferior leads, is an unrecognized surrogate of atrial dysfunction and a trigger of atrial dysrhythmias, mainly atrial fibrillation (AF). Our aim was to prospectively assess whether advanced IAB in sinus rhythm precedes AF and stroke in elderly outpatients with structural heart disease, a group not previously studied. Methods Prospective observational registry that included outpatients aged ≥70 years with structural heart disease and no previous diagnosis of AF. Patients were divided into three groups according to P-wave characteristics. Results Among 556 individuals, 223 had normal P-wave (40.1%), 196 partial IAB (35.3%), and 137 advanced IAB (24.6%). After a median follow-up of 694 days; 93 patients (16.7%) developed AF, 30 stroke (5.4%), and 34 died (6.1%). Advanced IAB was independently associated with AF (hazard ratio [HR] 2.9, 95% confidence interval [CI] 1.7–5.1, p<0.001), stroke (HR 3.8, 95% CI 1.4–10.7, p=0.010), and AF/stroke (HR 2.6, 95% CI 1.5–4.4, p=0.001). P-wave duration (ms) was independently associated with AF (HR 1.05, 95% CI 1.03–1.07, p<0.001), AF/stroke (HR 1.04, 95% CI 1.02–1.06, p<0.001), and mortality (HR 1.04, 95% CI 1.00–1.08, p=0.021). Conclusions The presence of advanced IAB in sinus rhythm is a risk factor for AF and stroke in an elderly population with structural heart disease and no previous diagnosis of AF. P-wave duration was also associated with all-cause mortality. Figure. Age- and sex-adjusted linear and non-linear association between P-wave duration (msec) and atrial fibrillation (A), stroke (B), and atrial fibrillation or stroke (C) risk. Results of a generalized additive model with spline smoothing functions and 4 degrees of freedom. Figure 1. Kaplan-Meyer curves of survival free of atrial fibrillation (A), stroke (B) and atrial fibrillation or stroke (C) in patients with normal P-wave, partial interatrial block (IAB) and advanced IAB. Funding Acknowledgement Type of funding source: None

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B-AB16-03 P WAVE PARADOX: CAN THE P WAVE DURATION ON 12 LEAD ELECTROCARDIOGRAPHY INFORM ATRIAL FIBRILLATION RECURRENCE AFTER CATHETER ABLATION

Heart Rhythm ◽

10.1016/j.hrthm.2021.06.094 ◽

2021 ◽

Vol 18 (8) ◽

pp. S31-S32

Author(s):

Michael Gardner ◽

Shruti Bidani ◽

Muzammil Khan ◽

Jianhui Zhu ◽

William W. Barrington ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

P Wave ◽

Atrial Fibrillation Recurrence ◽

Wave Duration ◽

P Wave Duration

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Signal-averaged P wave duration in patients with atrial fibrillation treated with radiofrequency catheter ablation

Heart Rhythm ◽

10.1016/j.hrthm.2005.02.570 ◽

2005 ◽

Vol 2 (5) ◽

pp. S182-S183

Author(s):

Brian Nilsson ◽

Ulrik Dixen ◽

Xu Chen ◽

Steen Pehrson ◽

Jesper H. Svendsen

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Radiofrequency Catheter Ablation ◽

P Wave ◽

Wave Duration ◽

P Wave Duration

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The significance of the morphology-voltage-P-wave duration (MVP) ECG score for prediction of in-hospital and long-term atrial fibrillation in ischemic stroke

Journal of Electrocardiology ◽

10.1016/j.jelectrocard.2021.09.006 ◽

2021 ◽

Author(s):

Mert İlker Hayıroğlu ◽

Tufan Çınar ◽

Murat Selçuk ◽

Göksel Çinier ◽

Bryce Alexander ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

P Wave ◽

Wave Duration ◽

P Wave Duration ◽

Ecg Score

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The effect of diabetic autonomic neuropathy on P-wave duration, dispersion and atrial fibrillation

Archives of Medical Science ◽

10.5114/aoms.2011.25555 ◽

2011 ◽

Vol 5 ◽

pp. 806-812 ◽

Cited By ~ 14

Author(s):

Andrzej Bissinger ◽

Tomasz Grycewicz ◽

Wlodzimierz Grabowicz ◽

Andrzej Lubinski

Keyword(s):

Atrial Fibrillation ◽

Autonomic Neuropathy ◽

Diabetic Autonomic Neuropathy ◽

P Wave ◽

Wave Duration ◽

P Wave Duration

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An Atrial Fibrillation with Normal Limits using Signal Processing- A Review

International Journal of Engineering & Technology ◽

10.14419/ijet.v7i2.24.12133 ◽

2018 ◽

Vol 7 (2.24) ◽

pp. 453

Author(s):

S. Sathish ◽

K Mohanasundaram

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Normal Sinus Rhythm ◽

P Wave ◽

Wave Duration ◽

Normal Limits ◽

Normal Sinus ◽

P Wave Duration ◽

Standard Lead ◽

Wave Morphology

Atrial fibrillation is an irregular heartbeat (arrhythmia) that can lead to the stroke, blood clots, heart failure and other heart related complications. This causes the symptoms like rapid and irregular heartbeat, fluttering, shortness of breath etc. In India for every around 4000 people eight of them are suffering from Atrial Fibrillation. P-wave Morphology. Abnormality of P-wave (Atrial ECG components) seen during sinus rhythm are associated with Atrial fibrillation. P-wave duration is the best predictor of preoperative atrial fibrillation. but the small amplitudes of atrial ECG and its gradual increase from isometric line create difficulties in defining the onset of P wave in the Standard Lead Limb system (SLL).Studies shows that prolonged P-wave have duration in patients (PAF) In this Study, a Modified Lead Limb (MLL) which solves the practical difficulties in analyzing the P-ta interval for both in healthy subjects and Atrial Fibrillation patients. P-Ta wave interval and P-wave duration can be estimated with following proposed steps which is applicable for both filtered and unfiltered atrial ECG components which follows as the clinical database trials. For the same the p-wave fibrillated signals that escalates the diagnosis follows by providing minimal energy to recurrent into a normal sinus rhythm.

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