What is the clinical evidence from this study?

Study design: Cohort. Population: Outpatients with sinus-rhythm ECGs (n=1500). Intervention: Abnormal PTFV1 vs. Normal PTFV1. Primary outcome: Incident atrial fibrillation (adjusted HR 1.35, 95% CI 1.03-1.77).

What question did this study set out to answer?

To assess how P-wave terminal force in lead V1 and deep terminal negativity of the P wave in V1 relate to the risk of atrial fibrillation and related adverse outcomes in outpatients.

February 28, 2026

Electrocardiographic atrial cardiomyopathy markers in sinus rhythm and the risk of incident atrial fibrillation and ischemic stroke a retrospective cohort study

Key Result

Abnormal PTFV1 on sinus-rhythm ECG independently predicted a higher risk of incident atrial fibrillation compared to normal PTFV1 (31.0% vs 16.1%; adjusted HR 1.35; 95% CI 1.03-1.77).

Key Points

To assess how P-wave terminal force in lead V1 and deep terminal negativity of the P wave in V1 relate to the risk of atrial fibrillation and related adverse outcomes in outpatients.
Conducted a retrospective cohort study of 1500 adults with sinus rhythm undergoing 12-lead ECG between September 2022 and September 2025.
Defined abnormal PTFV1 as ≥4000 μV·ms and DTNPV1 as biphasic P wave in V1 with terminal negativity >100 μV.
Used Cox proportional hazards models for multivariable adjustments.
Incident AF was observed in 301 patients (20.1%) over a median follow-up of 3.2 years, with higher rates in those with abnormal PTFV1 (31.0% vs 16.1%).
Abnormal PTFV1 predicted incident AF with an adjusted HR of 1.35 (95% CI 1.03-1.77).
Abnormal PTFV1 was also linked to higher rates of ischemic stroke/TIA (adjusted HR 1.34, 95% CI 1.01-1.78) and heart failure hospitalization (adjusted HR 1.22, 95% CI 1.01-1.48).

Study Design

Type

Cohort (n=1,500)

Structured PICO

Does abnormal PTFV1 or DTNPV1 on a sinus-rhythm ECG predict incident atrial fibrillation and adverse clinical outcomes in adult outpatients?

Population

1,500 consecutive adults undergoing clinically indicated outpatient 12-lead ECG in sinus rhythm

Intervention

Abnormal P-wave terminal force in lead V1 (PTFV1 ≥4000 μV·ms) and deep terminal negativity of the P wave in V1 (DTNPV1 >100 μV)

Comparator

Normal PTFV1 and normal DTNPV1

Outcome

Incident AF, defined as the first new AF episode after the index ECG requiring objective rhythm documentation on a 12-lead ECG/rhythm strip or ambulatory monitor report (≥30 s)hard clinical

Abnormal PTFV1 on a standard sinus-rhythm ECG is an independent predictor of incident atrial fibrillation, ischemic stroke, and heart failure hospitalization in outpatients.

Main Result

Effect estimate: adjusted HR 1.35 (95% CI 1.03-1.77)

Absolute Event Rate: 31% vs 16.1%

Abstract

BACKGROUND Electrocardiographic (ECG) markers of atrial cardiomyopathy obtained in sinus rhythm may help identify outpatients at increased risk of incident atrial fibrillation (AF) and related adverse outcomes. AIM To evaluate the associations of P-wave terminal force in lead V1 (PTFV1) and deep terminal negativity of the P wave in V1 (DTNPV1) with incident AF and clinical outcomes in a contemporary outpatient cohort. METHODS We conducted a retrospective cohort study of consecutive adults undergoing clinically indicated outpatient 12‑lead ECG in sinus rhythm between September 2022 and September 2025. Abnormal PTFV1 was defined as ≥4000 μV·ms and DTNPV1 as a biphasic P wave in V1 with terminal negative amplitude >100 μV. The primary endpoint was incident AF, defined as the first new AF episode after the index ECG requiring objective rhythm documentation on a 12‑lead ECG/rhythm strip or ambulatory monitor report (≥30 s); diagnostic codes alone were not sufficient. Secondary endpoints were incident ischemic stroke/TIA, heart failure (HF) hospitalization, all-cause mortality, and a composite outcome. Associations were assessed using Cox proportional hazards models with prespecified multivariable adjustment. RESULTS The final cohort included 1500 patients; 400 (26.7%) had abnormal PTFV1. Over a median follow-up of 3.2 years, incident AF occurred in 301 patients (20.1%). AF incidence was higher in the abnormal vs normal PTFV1 groups (31.0% vs 16.1%), and abnormal PTFV1 independently predicted incident AF (adjusted HR 1.35, 95% CI 1.03-1.77). Abnormal PTFV1 was also associated with incident stroke/TIA (7.8% vs 4.0%; adjusted HR 1.34, 95% CI 1.01-1.78), incident HF hospitalization (17.5% vs 10.0%; adjusted HR 1.22, 95% CI 1.01-1.48), and the composite endpoint (37.5% vs 30.0%; adjusted HR 1.28, 95% CI 1.10-1.48). All-cause mortality was numerically higher but not statistically significant after adjustment (6.3% vs 4.5%; adjusted HR 1.35, 95% CI 0.82-2.21). DTNPV1 was not independently associated with incident AF after adjustment. CONCLUSION In outpatients with sinus-rhythm ECGs, abnormal PTFV1 is independently associated with higher risk of incident AF and other clinically relevant outcomes, supporting its potential role in targeted rhythm surveillance and risk stratification.

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Cite This Study

Zorlu et al. (Fri,) conducted a cohort in Outpatients with sinus-rhythm ECGs (n=1,500). Abnormal PTFV1 vs. Normal PTFV1 was evaluated on Incident atrial fibrillation (adjusted HR 1.35, 95% CI 1.03-1.77). Abnormal PTFV1 on sinus-rhythm ECG independently predicted a higher risk of incident atrial fibrillation compared to normal PTFV1 (31.0% vs 16.1%; adjusted HR 1.35; 95% CI 1.03-1.77).

synapsesocial.com/papers/6a025a4b9cddff7633412af5 https://doi.org/https://doi.org/10.1016/j.jelectrocard.2026.154208

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