Prevalence of Electrocardiographic Abnormalities in Patients with Acute Pulmonary Embolism: A Systematic Review and...

Background/Objectives: Acute pulmonary embolism (PE) remains a leading cause of cardiovascular morbidity and mortality. Although computed tomography pulmonary angiography (CTPA) is the gold standard for diagnosis, electrocardiography (ECG) is a widely available, non-invasive tool that may provide diagnostic clues. This study aims to estimate the pooled prevalence of specific ECG abnormalities in patients with confirmed acute PE. Methods: We conducted a systematic review and meta-analysis in accordance with the PRISMA guidelines. We searched PubMed, Embase, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials until April 2024 for studies reporting prevalence data on ECG abnormalities in confirmed acute PE cases. Pooled prevalence estimates were calculated using a random-effects model, and heterogeneity was assessed using the I² statistic. Publication bias was evaluated through funnel plots and Egger's test. Results: Twenty-four studies with 7467 patients were included. The most common ECG abnormalities were sinus tachycardia (31%, 95% CI 22-40%), clockwise rotation (28%, 95% CI 12-45%), T-wave inversion in leads V1-V3 (18%, 95% CI 13-23%), S1Q3T3 pattern (15%, 95% CI 11-19%), and right bundle branch block (14%, 95% CI 10-17%). High heterogeneity was observed across studies, with an I² value exceeding 95%. Publication bias was detected for both S1Q3T3 and right bundle branch block. Conclusions: Sinus tachycardia and the S1Q3T3 pattern are frequently observed in acute PE, supporting their potential use in clinical recognition. However, significant heterogeneity and publication bias highlight the need for larger, higher-quality studies with standardized ECG protocols to understand ECG's diagnostic and prognostic role in PE.