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Association Between P-Wave Duration, Dispersion, and Interatrial Block and Atrial High-Rate Episodes in CIED
Phuuwadith Wattanachayakul1,2, Adivitch Sripusanapan3, Narathorn Kulthamrongsri4
1Department of Medicine, Jefferson Einstein Hospital, Philadelphia, Pennsylvania, USA.
Pacing and Clinical Electrophysiology : PACE
|October 5, 2024
Summary
Atrial high-rate episodes (AHRE) are linked to worse outcomes. This study found that longer P-wave duration and P-wave dispersion, along with interatrial block, predict AHRE development in patients with cardiac implantable electronic devices.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Atrial high-rate episodes (AHRE) are associated with increased thromboembolic risk and mortality in patients with cardiac implantable electronic devices (CIEDs).
- Identifying predictors of AHRE is crucial for monitoring and timely intervention, potentially preventing progression to clinical atrial fibrillation (AF).
- The predictive value of P wave characteristics for AHRE development requires further clarification.
Purpose of the Study:
- To conduct a meta-analysis investigating the association between baseline P wave characteristics (P-wave duration, P-wave dispersion, interatrial block) and the risk of developing AHRE.
- To summarize existing evidence on the predictive value of P wave abnormalities for AHRE in patients with CIEDs.
Main Methods:
- A systematic literature search of MEDLINE and EMBASE databases was performed up to May 2024.
- Meta-analysis of nine studies was conducted, pooling data on P-wave duration (PWD) and P-wave dispersion (PWDIS) using mean differences (MD).
- The association between interatrial block (IAB) and AHRE risk was assessed using risk ratios (RR) and generic inverse variance method.
Main Results:
- Patients who developed AHRE exhibited significantly longer PWD (MD: 9.17 ms; 95% CI: 4.74-13.60) and PWDIS (MD: 20.56 ms; 95% CI: 11.57-29.56) compared to those without AHRE.
- Interatrial block (IAB) was associated with a substantially higher risk of developing AHRE (RR: 3.33; 95% CI: 2.53-4.38).
- All pooled estimates showed statistical significance (p < 0.001) with moderate heterogeneity for PWD and PWDIS.
Conclusions:
- Elevated P-wave duration and P-wave dispersion are significant predictors of AHRE development in patients with CIEDs.
- Interatrial block is strongly associated with an increased risk of developing AHRE.
- These P wave abnormalities warrant consideration for risk stratification and enhanced monitoring in patients with CIEDs.
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