Baseline P-wave duration was significantly longer in cryptogenic stroke survivors with newly diagnosed atrial fibrillation compared to those in sinus rhythm (MD 6.36 ms; 95% CI 0.69-12.03; p=0.03).
Meta-Analysis (n=1,508)
Do prolonged P-wave duration and increased P-wave dispersion predict newly diagnosed atrial fibrillation in cryptogenic stroke survivors?
Prolonged baseline P-wave duration may serve as a non-invasive ECG marker to predict newly diagnosed atrial fibrillation in cryptogenic stroke survivors.
Effect estimate: MD 6.36 ms (95% CI 0.69-12.03)
p-value: p=0.03
ABSTRACT Background 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. Methods 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. Results 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. Conclusion 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. Trial Registration PROSPERO: CRD42025646135
Balweel et al. (2025) conducted a meta-analysis in Cryptogenic stroke (n=1,508). Newly diagnosed atrial fibrillation (NDAF) vs. Sinus rhythm (no NDAF) was evaluated on Baseline P-wave duration (PWDur) (MD 6.36 ms, 95% CI 0.69-12.03, p=0.03). Baseline P-wave duration was significantly longer in cryptogenic stroke survivors with newly diagnosed atrial fibrillation compared to those in sinus rhythm (MD 6.36 ms; 95% CI 0.69-12.03; p=0.03).