Key result
P wave morphological variability increases ~19% before AF onset, showing higher reactivity than other parameters.
Why the study?
Short-term characterization of P waves before AF onset is challenged by a low signal-to-noise ratio that makes P wave delineation difficult.
Does the P wave morphological variability parameter better reflect short-term instability before AF onset compared to other P wave variability parameters?
Observational (n=32)
Does the P wave morphological variability parameter better reflect short-term instability before AF onset compared to other P wave variability parameters?
The P wave morphological variability parameter is superior to traditional parameters in detecting short-term atrial substrate instability prior to AF onset.
New MV parameter detects pre-AF P-wave instability; leaves open whether it improves risk stratification or outperforms prior metrics in prospective use.
Short-term characterization of P waves occurring before the onset of atrial fibrillation (AF) is essential to better understand triggering mechanisms. The characterization is challenged by a low signal-to-noise ratio which makes P wave delineation difficult. This study compares the performance of a parameter characterizing P wave morphological variability (MV) to that of four previously published P wave variability parameters: amplitude dispersion, duration, arc length, and power ratio of principal components. The comparison is based on the St.Petersburg Atrial Fibrillation Database comprising 176 one-hour sinus rhythm segments just before AF onset, obtained from 32 patients. Following a linear, spatial transformation that emphasizes the P wave, the MV parameter is computed in consecutive, overlapping subsegments and normalized by a reference value taken one hour before AF onset. The results show that the MV parameter exhibits the highest reactivity to AF onset, with a mean relative increase of 19% 10 min before AF onset, whereas the other four parameters had lower reactivities (amplitude dispersion: 10%, duration: 0%, arc length: 10%, and power ratio: 2%). The conclusion is that the MV parameter better reflects the short-term instability of the atrial substrate than the other parameters.
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Noriega et al. (2026) conducted an observational in Atrial fibrillation (n=32). P wave morphological variability (MV) parameter vs. Amplitude dispersion, duration, arc length, and power ratio of principal components was evaluated on Mean relative increase in parameter 10 min before AF onset. The P wave morphological variability parameter showed higher reactivity to atrial fibrillation onset (19% mean relative increase at 10 min) compared to four other parameters (0-10%).
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