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Usefulness of P Wave Duration in Embolic Stroke of Undetermined Source
Moonki Jung1, Jin-Seok Kim2, Ju Hyeon Song1
1Cardiovascular & Arrhythmia Center, Chung-Ang University Hospital, Chung-Ang University, Seoul 06973, Korea.
Insights
P wave duration (PWD) measured by signal-averaged electrocardiography (SAECG) can predict subclinical atrial fibrillation (SCAF) in embolic stroke of undetermined source (ESUS) patients. Prolonged PWD also robustly predicts recurrent stroke.
Area of Science:
- Cardiology
- Neurology
- Biomarkers
Background:
- Subclinical atrial fibrillation (SCAF) is a risk factor for recurrent stroke.
- Identifying SCAF aids in secondary stroke prevention strategies.
- P wave signal-averaged electrocardiography (SAECG) assesses atrial electrical activity.
Purpose of the Study:
- To evaluate if P wave signal-averaged electrocardiography (SAECG) can predict subclinical atrial fibrillation (SCAF) in patients with embolic stroke of undetermined source (ESUS).
- To determine the association between P wave duration (PWD) and SCAF detection.
- To assess the predictive value of PWD and SCAF for stroke recurrence.
Main Methods:
- Recruited 125 ESUS patients and 125 paroxysmal atrial fibrillation controls.
- All participants underwent baseline P wave SAECG.
- ESUS patients were followed with Holter monitoring and ECG for up to 12 months.
Main Results:
- Subclinical atrial fibrillation (SCAF) was detected in 25.6% of ESUS patients during follow-up.
- P wave duration (PWD) was a significant predictor of SCAF.
- Prolonged PWD (≥ 135 ms) was a more robust predictor of stroke recurrence than SCAF detection.
Conclusions:
- P wave duration (PWD) is a valuable biomarker for predicting SCAF in ESUS patients.
- PWD can identify ESUS patients at higher risk for recurrent embolic stroke.
- Further research is warranted to confirm the clinical utility of PWD.
Abstract:
The investigation of the potential association between ischemic stroke and subclinical atrial fibrillation (SCAF) is important for secondary prevention. We aimed to determine whether SCAF can be predicted by atrial substrate measurement with P wave signal-averaged electrocardiography (SAECG). We recruited 125 consecutive patients with embolic stroke of undetermined source (ESUS) and 125 patients with paroxysmal atrial fibrillation as controls. All participants underwent P wave SAECG at baseline, and patients with ESUS were followed up with Holter monitoring and electrocardiography at baseline, 3, 6, and 12 months after discharge and every 6 months thereafter. In the ESUS group, 32 (25.6%) patients were diagnosed with SCAF during follow-up. There were no significant differences between the groups regarding atrial substrate. P wave duration (PWD) was a significant predictor of SCAF. Stroke recurrence occurred in 22 patients (17.6%), and prolonged PWD (≥ 135 ms) predicted stroke recurrence more robustly than SCAF detection. In ESUS patients, PWD can be a useful biomarker to predict SCAF and to identify patients who are more likely to have a recurrent embolic stroke associated with an atrial cardiopathy. Further research is needed for supporting the utility and applicability of PWD.
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