Related Experiment Video
Updated: Sep 20, 2026
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Can P wave parameters obtained from 12-lead surface electrocardiogram be a predictor for atrial fibrillation in
Bülent B Altunkeser1, Kurtuluş Ozdemir, Hasan Gök
1Department of Cardiology, Faculty of Medicine, Selçuk University, Konya, Turkey. bbaltunkeser@hotmail.com
Insights
Maximum P wave duration and left atrial diameter predict chronic atrial fibrillation (AF) risk in patients with structural heart disease and sinus rhythm. These ECG and echocardiography parameters help identify individuals at higher risk for developing AF.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Diagnostics
Background:
- Atrial fibrillation (AF) is a common arrhythmia, particularly in patients with structural heart disease.
- Identifying reliable predictors of AF development in patients with sinus rhythm and structural heart disease is crucial for risk stratification and preventative strategies.
- Existing methods for risk assessment may not fully capture the electrophysiological and structural changes associated with AF development.
Purpose of the Study:
- To investigate electrocardiography (ECG) and echocardiography parameters that detect the risk of developing atrial fibrillation (AF) in patients with sinus rhythm and structural heart disease.
- To identify independent predictors of chronic AF in this patient population.
Main Methods:
- A study included 45 patients with AF and 37 patients without AF but with structural heart disease, all in sinus rhythm.
- Echocardiography measured left ventricular ejection fraction (LVEF) and left atrial diameter (LAD).
- 12-lead ECG recorded P wave duration (P max, P min) and amplitude (P amp max, P amp min) to calculate P wave duration dispersion (P dispersion) and P wave amplitude dispersion (P amp dispersion).
Main Results:
- Univariate analysis identified P max, P dispersion, P amp max, P amp dispersion, LAD, LVEF, and older age as significant predictors of chronic AF.
- Multivariate analysis revealed that maximum P wave duration (P max) and left atrial diameter (LAD) were independent predictors of chronic AF.
- P max and LAD showed significant predictive value (r = 0.39, p < 0.05 and r = 0.34, p < 0.05, respectively).
Conclusions:
- Maximum P wave duration (P max) and left atrial diameter (LAD) are valuable predictive parameters for estimating the risk of developing chronic AF.
- These parameters are particularly useful in patients who have sinus rhythm but also exhibit structural heart disease.
- The findings suggest that integrating ECG-derived P wave characteristics and echocardiographic LAD measurements can enhance AF risk assessment in relevant patient cohorts.
Abstract:
This study was planned to investigate the parameters detecting risk of developing atrial fibrillation (AF) in patients with sinus rhythm with structural heart disease. Forty-five patients with AF and 37 patients without AF but with structural heart disease (Group I) were included in this study. Thirty-eight patients (Group II) had successfully undergone medically or electrically cardioversion after transesophageal echocardiography. The restoration of sinus rhythm could not be achieved in 7 patients who were excluded from this study. After providing sinus rhythm, amiodarone was given orally to the patients to prevent recurrences. Left ventricular ejection fraction (LVEF) was calculated and left atrial diameter (LAD) was measured by echocardiography in group I and in group II after cardioversion. A 12-lead electrocardiography (ECG) was simultaneously obtained from all the patients. In these ECG recordings, maximum P wave duration (P max), minimum P wave duration (P min), and P wave dispersion (P dispersion) were calculated. P dispersion was expressed as "P max-P min." Also, the highest P wave voltage is expressed as P amplitude maximum (P amp max), the lowest P wave as P amplitude minimum (P amp min), and P amplitude dispersion (P amp dispersion) was calculated as the difference of both. In univariate analysis, P max, P dispersion, P amp max, P amp dispersion, LAD, LVEF, and old age were significant predictors of chronic AF (p < 0.001, p < 0.01, p < 0.01, p < 0.01, p = 0.003, p = 0.02, and p = 0.01, respectively). However, in multivariate analysis, P max and LAD were independent predictors of chronic AF in patients with structural heart disease (r = 0.39, p < 0.05; r = 0.34; p < 0.05, respectively). In conclusion, in estimating the risk of developing chronic AF, P max and LAD are predictive parameters in patients with sinus rhythm with structural heart disease.
Related Concept Videos
01:28Electrocardiogram Fundamentals
An electrocardiogram (ECG) is a diagnostic tool for identifying cardiac conditions such as arrhythmias, conduction abnormalities, and myocardial ischemia.
Definition
An electrocardiogram (ECG) visualizes the heart's electrical activity by tracing the electrical movement associated with each heartbeat on a graph or monitor. As the heart beats, an electrical wave passes through it, correlating with the cardiac cycle events.
Parts of an ECG
An ECG utilizes electrodes on the skin to...
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
01:29Dysrhythmias III: Characteristics of Dysrhythmias
01:30Dysrhythmias V: Evaluating Dysrhythmias
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and the T...
01:18Dysrhythmias IV: Characteristics of Bradyarrhythmias