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Published on: February 26, 2013
Prevalence and progression of P-wave abnormalities in patients with atrial fibrillation
Arto Relander1, Johanna Kääriä1, Samuli Jaakkola1
1Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
Insights
P-wave abnormalities (PWAs) are common and progress rapidly in atrial fibrillation (AF) patients, driven by aging and cardiovascular issues. These ECG changes indicate a high prevalence and progression rate in AF.
Area of Science:
- Cardiology
- Electrocardiography
Background:
- P-wave indices on electrocardiograms (ECGs) are linked to cardiovascular diseases like atrial fibrillation (AF) and stroke.
- Limited data exists on the stability and progression of these P-wave abnormalities (PWAs).
Purpose of the Study:
- To investigate the prevalence, progression, and risk factors of P-wave abnormalities (PWAs) in patients with atrial fibrillation (AF).
Main Methods:
- Analyzed 3 sinus rhythm ECGs from 1316 individuals undergoing cardioversion (CV) for acute AF.
- Defined moderate and extensive PWAs based on P-wave duration, P-terminal force, interatrial block criteria, and P-wave morphology.
Main Results:
- Significant progression from normal P waves to moderate and extensive PWAs was observed both before and after cardioversion.
- At follow-up, 38.7% had moderate PWAs and 33.5% had extensive PWAs.
- Independent risk factors for persistent/progressive PWAs included age, heart failure, hypertension, vascular disease, prior AF, frequent CV, left ventricular hypertrophy, and wide QRS complex.
Conclusions:
- P-wave abnormalities (PWAs) are highly prevalent and progress rapidly in AF patients.
- Progression is primarily influenced by aging, chronic cardiovascular conditions, and recurrent AF episodes.
Background:
Various electrocardiographic P-wave indices are associated with cardiovascular comorbidities, such as atrial fibrillation (AF) and stroke. However, information on their stability is limited.
Objective:
This study explored the prevalence and progression of P-wave abnormalities (PWAs) as well as their risk factors in an AF population.
Methods:
PWAs were identified in a series of 3 sinus rhythm electrocardiograms (ECGs) of 1316 individuals undergoing the index cardioversion (CV) for acute AF in the FinCV study. Patients were assigned to the category of extensive PWA if they had P-wave duration ≥180 ms, P-terminal force ≥80 mm·ms, advanced interatrial block (biphasic P waves in inferior leads and P-wave duration ≥120 ms), or deflected P-wave morphology; moderate PWA consisted of P-wave duration of 150-180 ms or P-terminal force of 40-80 mm·ms.
Results:
Between pre-CV and index CV ECGs, 133 of 342 (38.9%) and 54 of 342 (15.8%) patients progressed from normal P wave to moderate and extensive PWAs, respectively. During the follow-up after index CV, the respective rates were 131 of 407 (32.2%) and 74 of 407 (18.2%). At the end of follow-up, prevalence for normal P wave was 311 of 1121 (27.7%), whereas 434 (38.7%) patients had moderate PWA and 376 (33.5%) had extensive PWA. Increasing age, heart failure, hypertension, vascular disease, history of previous AF episodes, high CV frequency, left ventricular hypertrophy, and wide QRS complex in the ECG were independent risk factors for persistent or progressive PWA status in a Cox regression analysis.
Conclusion:
The prevalence and rate of progression of PWA are high in this cohort of AF patients, with development mainly driven by aging, chronic cardiovascular conditions, and frequent AF recurrences.
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