Electrocardiographic Predictors of Early Atrial Fibrillation After Transcatheter Atrial Septal Defect Closure: The Roles of P-Wave Dispersion and P-Terminal Force in V1

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Secundum atrial septal defect undergoing transcatheter closure (n=555). Intervention: P-terminal force in V1 (PTFV1) and P-wave dispersion (PWDis) vs. Normal/lower PTFV1 and PWDis values (patients without early AF). Primary outcome: Early atrial fibrillation within 48 hours post-procedure (predicted by PTFV1) (OR 1.086, 95% CI 1.027-1.149, p=0.004).

Q: What does this research mean for the field?

Elevated preprocedural P-wave dispersion and P-terminal force in V1 independently predict early atrial fibrillation within 48 hours following transcatheter atrial septal defect closure. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Yusuf Demir; Ahmet Anıl Başkurt; Samet Sevinç; Oktay Şenöz

doi:10.4274/forbes.galenos.2026.84666

October 14, 2026Forbes Journal of MedicineOpen Access

Electrocardiographic Predictors of Early Atrial Fibrillation After Transcatheter Atrial Septal Defect Closure: The Roles of P-Wave Dispersion and P-Terminal Force in V1

View Full Paper

Ask AI

Bookmark

Share

Key result

Baseline PTFV1 is linked to ~9% higher odds of early AF after percutaneous ASD closure.

OR 1.086
95% CI 1.027-1.149
P=0.004
n=555

Why the study?

Early AF can complicate transcatheter ASD closure, but simple ECG predictors such as baseline P-wave dispersion (PWDis) and P-terminal force in V1 (PTFV1) remain underused.

Do baseline P-wave dispersion and P-terminal force in V1 predict early atrial fibrillation within 48 hours in adults undergoing transcatheter secundum atrial septal defect closure?

Key Points

Investigate whether baseline P-wave dispersion (PWDis) and P-terminal force in lead V1 (PTFV1) predict the development of early atrial fibrillation within 48 hours following transcatheter atrial septal defect closure.
Retrospective two-center cohort study evaluating 555 consecutive adult patients (aged 18–85 years) who underwent successful percutaneous secundum atrial septal defect closure between March 2015 and September 2024.
Preprocedural 12-lead electrocardiograms were digitized at 4× magnification to measure PWDis (maximum minus minimum P-wave duration) and PTFV1 (product of terminal negative P-wave duration and amplitude in lead V1).
Early atrial fibrillation occurred in 27 of 555 patients (4.9%) within 48 hours post-procedure; affected patients had significantly higher baseline PWDis (42.8±13.9 vs. 36.4±11.8 ms, p=0.007) and PTFV1 (4325.9±730.4 vs. 3876.5±656.1 µV·ms, p=0.001).
Multivariable logistic regression demonstrated that both PWDis (OR 1.036; 95% CI 1.004–1.068; p=0.025) and PTFV1 (OR 1.086; 95% CI 1.027–1.149; p=0.004) independently predicted early atrial fibrillation.
Receiver operating characteristic analysis identified optimal predictive cut-offs of PTFV1 >4,050 µV·ms (AUC 0.681; sensitivity 63%; specificity 62%) and PWDis >36.5 ms (AUC 0.634; sensitivity 57%; specificity 61%).

Study Design

Type

Cohort (n=555)

Blinding

Blinded outcome assessment

Multicenter

Yes

Structured PICO

Do baseline P-wave dispersion and P-terminal force in V1 predict early atrial fibrillation within 48 hours in adults undergoing transcatheter secundum atrial septal defect closure?

P

Population

555 adults (mean age 39.1 years, 68.5% female) undergoing successful percutaneous secundum ASD closure, free of prior AF and coronary artery disease, monitored for 48 hours.

E

Exposure

Preprocedural baseline 12-lead ECG measurement of P-wave dispersion (PWDis, difference between maximum and minimum P-wave duration across 12 leads) and P-terminal force in lead V1 (PTFV1, product of duration and amplitude of terminal negative P-wave component in V1 in µV·ms) prior to transcatheter secundum ASD closure.

O

Outcome

Early atrial fibrillation (defined as an irregularly irregular rhythm without discernible P waves lasting ≥30 seconds on surface ECG or Holter monitoring) within 48 hours post-procedure.hard clinical

Main Result

Odds Ratio: 1.086 (95% CI 1.027–1.149)

p-value: p=0.004

Preprocedural P-wave dispersion and P-terminal force in lead V1 on standard 12-lead ECG independently predict early atrial fibrillation within 48 hours after percutaneous secundum ASD closure, offering low-cost tools for peri-procedural risk stratification.

Limitations

Retrospective study design
Non-continuous rhythm monitoring after the first 24 hours may have missed short-term or asymptomatic AF episodes
Manual ECG analysis from digitized recordings is subject to measurement variability
Relatively small number of AF events (n=27) limited the complexity of multivariate modeling
Modest discriminatory performance on ROC analysis
Rhythm monitoring after the first 24 hours relied on bedside monitoring systems and symptom-triggered ECG recordings rather than continuous telemetry, potentially missing asymptomatic or short-term AF episodes
Manual measurement of PWDis and PTFV1 from digitized ECG recordings may be subject to measurement variability
Relatively small number of AF events (n=27) limited the complexity of multivariate modeling and may have increased the risk of model instability or overfitting

Implication

May identify high-risk ASD closure patients for closer monitoring; hypothesis-generating pending prospective validation.

Abstract

Objective: Early atrial fibrillation (AF) can complicate transcatheter atrial septal defect (ASD) closure, yet simple electrocardiographic predictors remain underused.We investigated whether baseline P-wave dispersion (PWDis) and P-terminal force in V1 (PTFV1) predicted AF within 48 hours post-procedure. Methods:We conducted a retrospective, two-center cohort study including 555 consecutive adults (18-85 years) who underwent successful percutaneous secundum ASD closure between March 2015 and September 2024.Patients with prior AF, coronary artery disease, failed procedures, emergent surgery, in-hospital death within 48 hours, suboptimal records, or unavailable preprocedural ECGs were excluded.Baseline 12-lead ECGs (25 mm/s, 10 mm/mV; 0.05-100 Hz) were digitized and measured at 4× magnification.PWDis was calculated as the difference between maximum and minimum P-wave duration across 12 leads; PTFV1 was defined as the product of the duration and amplitude of the terminal negative P-wave component in V1 (µV•ms).Results: Of 555 patients, 27 (4.9%)developed AF within 48 hours.Patients with AF were older (59.6±13.1 vs. 37.9±14.7 years, p<0.001) and more often NYHA class II (p<0.001).On ECG, PWDis and PTFV1 were significantly higher in the AF group (PWDis 42.8±13.9vs. 36.4±11.8ms, p=0.007;PTFV1 4325.9±730.4 vs. 3876.5±656.1 µV•ms, p=0.001).Both PWDis [odds ratio (OR) 1.036; 95% confidence interval (CI) 1.004-1.068;p=0.025] and PTFV1 (OR 1.086; 95% CI 1.027-1.149;p=0.004) independently predicted AF.ROC analysis identified PTFV1 >4,050 µV•ms and PWDis >36.5 ms as predictors of early AF.Conclusion: Preprocedural PWDis and PTFV1 independently predict early AF after ASD device closure.These ubiquitous, low-cost ECG indices may help risk-stratify candidates and tailor peri-procedural monitoring and prophylaxis strategies.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Demir et al. (2026) conducted a cohort in Secundum atrial septal defect undergoing transcatheter closure (n=555). P-terminal force in V1 (PTFV1) and P-wave dispersion (PWDis) vs. Normal/lower PTFV1 and PWDis values (patients without early AF) was evaluated on Early atrial fibrillation within 48 hours post-procedure (predicted by PTFV1) (OR 1.086, 95% CI 1.027-1.149, p=0.004). Baseline PTFV1 (OR 1.086, p=0.004) and P-wave dispersion (OR 1.036, p=0.025) independently predicted early atrial fibrillation within 48 hours after percutaneous ASD closure.

synapsesocial.com/papers/6ae28e56cbadf70daf6c41e4 https://doi.org/10.4274/forbes.galenos.2026.84666

View Full Paper

Ask AI

Bookmark

Share

Electrocardiographic Predictors of Early Atrial Fibrillation After Transcatheter Atrial Septal Defect Closure: The Roles of P-Wave Dispersion and P-Terminal Force in V1

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Electrocardiographic Predictors of Early Atrial Fibrillation After Transcatheter Atrial Septal Defect Closure: The Roles of P-Wave Dispersion and P-Terminal Force in V1

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading