Why the study?
Atrial fibrillation reflects structural and conduction abnormalities of the atria, and the P-wave axis on a 12-lead ECG may serve as a sensitive parameter to predict incident AF.
Does an abnormal P-wave axis predict incident atrial fibrillation?
Does an abnormal P-wave axis predict incident atrial fibrillation?
An abnormal P-wave axis (<0° or >75°) on a standard 12-lead ECG is associated with a more than twofold increased risk of incident atrial fibrillation, highlighting its potential utility for risk stratification.
Abnormal P-wave axis may aid AF risk stratification on routine ECG; leaves open prospective validation before clinical adoption.
INTRODUCTION: There is growing interest in the prediction of incident atrial fibrillation (AF). The 12-lead electrocardiogram (ECG) has been a particularly rich target for possible prediction strategies. PURPOSE: The P-wave axis is an ECG parameter that reflects the dominant vector of atrial depolarisation and is usually 0° -75°. There is a large body of literature suggesting that AF reflects structural and conduction abnormalities of the atria, and thus the P-wave axis may represent a sensitive parameter to detect such changes. METHODS: A systematic review and meta-analysis of published literature associating abnormal P-wave axis and the development of incident AF was performed. Electronic databases were systematically searched from inception to October 2021. A random-effects model with generic inverse variance weights was utilised to pool the most adjusted effect measure from each paper. A funnel plot was used to assess publication bias. RESULTS: After excluding duplicate studies, 568 studies were screened. A total of eleven studies were identified that associated an abnormal P-wave axis with the subsequent detection of AF. The eight studies that considered abnormal P-wave axis as being <0° or >75° were pooled for meta-analysis. In the pooled studies a total of 78,222 patients were included with 5656 cases of incident atrial fibrillation identified. The meta-analysis of the studies suggested that an abnormal P-wave axis was associated with a pooled risk ratio of 2.12 (95% CI 1.49 to 3.01) for the detection of incident atrial fibrillation. CONCLUSION: This comprehensive systematic review and meta-analysis, indicates the positive association of abnormal P wave axis and future detection of AF. Utilisation of abnormal P-wave axis, alongside other parameters, may allow clinicians to better risk-stratify individuals at increased risk of AF, and thus identify those who may benefit most from prolonged cardiac monitoring or targeted anticoagulation.
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Chattopadhyay et al. (2022) studied this question.
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