Why the study?
Does an increased duration of the initial P wave portion in lead III predict the development of atrial fibrillation in patients with a biphasic P wave in lead II?
Cohort (n=141)
No
Does an increased duration of the initial P wave portion in lead III predict the development of atrial fibrillation in patients with a biphasic P wave in lead II?
Hazard Ratio: 2.9 (95% CI 1.16–7.11)
p-value: p=0.02
Detailed P wave analysis, specifically the duration of the initial portion in lead III, can help identify patients at high risk for developing atrial fibrillation.
May support AF risk stratification in biphasic lead II cases; leaves open prospective validation and added value beyond standard predictors.
BACKGROUND: Anisotropic and slow conduction in the atrium underlie the development of atrial fibrillation (AF). This study aimed to investigate the P wave characteristics associated with the development of AF in patients with a biphasic P wave in the inferior leads. METHODS: Digital analysis of retrospectively recorded 12-lead electrocardiograms was performed to select patients with a biphasic P wave (positive/negative) in lead II from a database of 114,334 patients. Characteristics of the P wave in the inferior leads associated with incidence of AF were determined. Receiver operating characteristic curves dichotomized P wave variables were measured in each lead. RESULTS: A total of 141 patients (77 men; mean age, 64±19 years) were enrolled in this study. Twenty-nine (20.6%) patients developed AF (AF group) vs. 112 (79.6%) who did not (non-AF group) during a follow-up period of 50±62 months. The amplitude of the initial P wave portion in lead II was significantly larger in the AF group when compared with the non-AF group (77.3±77.0 µV vs. 51.0±30.1 µV, p=0.003), while the amplitude of the terminal P wave portion in lead III was significantly decreased in the AF group when compared with the non-AF group (-70.6±41.3 µV vs. -89.1±38.1 µV, p=0.024). The duration of the initial P wave portion in lead III was significantly longer in the AF group when compared with the non-AF group (52.7±34.6 ms vs. 35.8±30.4 ms, p=0.011). Multivariate Cox proportional-hazards analysis confirmed that the increased duration of the initial P wave portion in lead III (≥71 ms) was independently associated with AF development (hazard ratio 2.90, 95% confidence interval 1.16-7.11, p=0.02). CONCLUSION: The analyses of the biphasic P wave in the inferior leads suggest that the development of AF could be attributed to increased atrial slow conduction.
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Hayashi et al. (2015) conducted a cohort in Biphasic P wave in lead II (n=141). Increased duration of the initial P wave portion in lead III (≥71 ms) vs. Duration of the initial P wave portion in lead III <71 ms was evaluated on Development of atrial fibrillation (HR 2.90, 95% CI 1.16-7.11, p=0.02).
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