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Updated: Feb 26, 2026
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Atrial time and voltage dispersion are both needed to predict new-onset atrial fibrillation in ischemic stroke
Daniel Cortez1,2, Maria Baturova3,4,5, Arne Lindgren6,7
1Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden. dr.danielcortez@gmail.com.
Insights
The ratio of P-wave duration to P-wave vector magnitude (Pd/Pvm) is a key electrocardiogram (ECG) predictor for new-onset atrial fibrillation (AF) in stroke patients. This finding may help identify individuals at higher risk for AF after a stroke.
Area of Science:
- Cardiology
- Neurology
- Medical Diagnostics
Background:
- Atrial fibrillation (AF) is a significant risk factor for ischemic stroke.
- Previous studies identified P-wave duration and QRS vector magnitude as predictors for AF and ventricular arrhythmias, respectively.
- The predictive value of three-dimensional P-wave vector magnitude for new-onset AF post-stroke requires further investigation.
Purpose of the Study:
- To assess the predictive value of the three-dimensional P-wave vector magnitude and its relationship to P-wave duration for new-onset AF after ischemic stroke.
- To determine if ECG parameters can identify stroke patients at risk for developing AF.
- To evaluate the Pd/Pvm ratio as an independent predictor of AF in ischemic stroke survivors.
Main Methods:
- Inclusion of first-ever ischemic stroke patients without AF from the Lund Stroke Register.
- Automatic measurement of ECG parameters including P-wave duration (Pd) and calculation of P-wave vector magnitude (Pvm) using a validated algorithm.
- Calculation of the Pd/Pvm ratio and multivariate analysis to identify predictors of new-onset AF.
Main Results:
- The study included 227 patients (135 males, 92 females) with a median age of 73 years.
- Multivariate predictors for new-onset AF included age > 65 years, hypertension, and the Pd/Pvm ratio.
- The Pd/Pvm ratio was the sole independent ECG predictor of AF, with a hazard ratio of 2.02 (p=0.010). A cut-off of 870 ms/mV showed 51% sensitivity and 79% specificity.
Conclusions:
- P-wave dispersion, quantified by the Pd/Pvm ratio, independently predicts subsequent AF identification in stroke patients.
- The Pd/Pvm ratio emerged as a significant ECG marker for AF risk stratification post-stroke.
- Further prospective studies in larger cohorts are recommended to confirm the clinical utility of Pd/Pvm for AF prediction.
Background:
Atrial fibrillation (AF) is a known risk factor for ischemic stroke. Electrocardiographic predictors of AF in population studies such as the Framingham Heart Study, as well as in hypertensive patients have demonstrated a predictive value of the P-wave duration for development of AF. QRS vector magnitude has had a predictive value in ventricular arrhythmia development. We aimed to assess the value of the three-dimensional P-wave vector magnitude and its relationship to P-wave duration for prediction of new-onset AF after ischemic stroke.
Methods:
First-ever ischemic stroke patients without AF at inclusion in the Lund Stroke Register were included. Measurements of P wave duration (Pd), QRS duration, corrected QT interval, and PQ interval were performed automatically using the University of Glasgow 12-lead ECG analysis algorithm. The P-wave vector magnitude (Pvm) was calculated automatically as the square root of the sum of the squared P-wave magnitudes in leads V6, II and one half of the P-wave amplitude in V2 ([Formula: see text]), based on the P-wave magnitude (Pvm) as defined by the visually transformed Kors' Quasi-orthogonal method.
Results:
The median age was 73 (IQR 63-80) years at stroke onset (135 males, 92 females). Multivariate predictors of new-onset atrial fibrillation included age > 65 years, hypertension, and Pd/Pvm. A cut-off value of 870 ms/mV gave sensitivity, specificity, positive and negative predictive values of 51, 79, 30 and 87%, respectively. The Pd/Pvm was the only ECG predictor of AF with a significant multivariate hazard ratio of 2.02 (95% CI 1.18 to 3.46, p = 0.010).
Conclusion:
P-wave dispersion as measured by the Pd/Pvm was the only ECG parameter measured which independently predicted subsequent AF identification in a cohort of stroke patients. Further prospective studies in larger cohorts are needed to validate its clinical usefulness.
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