Newly Diagnosed Atrial Fibrillation Indicators in Cryptogenic Stroke Survivors' P-Wave Indices: A Systematic Review...

Atrial fibrillation (AF) is the most common arrhythmia and a major cause of ischemic stroke recurrence. Cryptogenic stroke (CS) survivors face a higher risk for newly diagnosed AF (NDAF), with subtle ECG markers-prolonged P-wave duration (PWDur) and increased P-wave dispersion (PWDis)-potentially serving as early indicators. We aimed to quantify baseline PWDur and PWDis differences between CS survivors with NDAF and those in sinus rhythm.

Following PRISMA guidelines, we systematically searched nine databases through January 2025 for observational studies assessing baseline P-wave indices in adult CS patients in sinus rhythm. Data extraction and risk of bias assessment using the ROBINS-E tool were performed independently. Pooled mean differences (MD) with 95% confidence intervals (CI) were calculated using a random-effects inverse-variance model. Subgroup/sensitivity analyses were conducted by age groups, male proportion, region, follow-up duration, percentage of comorbidities, AF definition and detection methods, and ECG parameter. Heterogeneity was assessed using Cochran's Q, τ ², and I ² and interpreted using Cochrane thresholds; certainty was appraised with GRADE.

Ten studies, encompassing 1508 patients (mean age 66.72 ± 13.74 years; 55.7% male), met the inclusion criteria. Baseline PWDur was longer in the NDAF (MD 6.36 ms, 95% CI: 0.69-12.03, p = 0.03, I ² = 73%, GRADE: moderate). Sensitivity analysis confirmed the robustness. PWDis remained non-significant.

Prolonged baseline PWDur may serve as a non-invasive marker of atrial conduction abnormalities and a predictor of AF in CS survivors. Larger prospective studies are needed to validate its role in risk stratification and secondary stroke prevention.

PROSPERO: CRD42025646135.