Key result
Advanced interatrial block is linked to ~2.5-fold higher odds of new-onset atrial fibrillation.
Why the study?
Early identification of AF is difficult because it is often asymptomatic. Although ECG P-wave morphology has been proposed as a predictor of AF, previous findings on its association with new-onset AF have remained inconsistent.
Does electrocardiographic P-wave morphology (such as prolonged P-wave duration and interatrial block) predict the occurrence of new-onset atrial fibrillation in individuals without a prior diagnosis of atrial fibrillation?
Meta-Analysis (n=4,331)
Does electrocardiographic P-wave morphology (such as prolonged P-wave duration and interatrial block) predict the occurrence of new-onset atrial fibrillation in individuals without a prior diagnosis of atrial fibrillation?
Prolonged P-wave duration and both partial and advanced interatrial block on surface ECG are significantly associated with an increased risk of developing new-onset atrial fibrillation, whereas P-wave amplitude and dispersion are not.
May identify higher-risk patients for new-onset AF; leaves open prospective validation before clinical adoption.
Introduction: Atrial fibrillation (AF) is linked to substantial morbidity and mortality due to its association with stroke and embolism. Early identification is difficult because AF is often asymptomatic. Electrocardiographic (ECG) features, particularly P-wave morphology, have been proposed as predictors of AF. However, previous findings remain inconsistent. This study evaluates the association between P-wave morphology and new-onset atrial fibrillation (NOAF). Material and methods: Data were retrieved from PubMed, ScienceDirect, Cochrane Library, ProQuest, and Sage Journal. Eligible studies used cohort or case-control designs involving NOAF populations and reported ECG parameters of P-wave morphology. The end-point was NOAF occurrence. Outcomes were expressed as odds ratios (ORs) for categorical variables and standardized mean differences (SMDs) for continuous variables, each with 95% confidence intervals (CI). Results: Ten cohort studies (854 NOAF and 3477 non-NOAF patients) were included. Patients who developed NOAF had significantly longer P-wave duration than those who did not (SMD = 0.29, 95% CI = 0.17-0.41, p < 0.05). Both partial and advanced interatrial blocks were significantly associated with NOAF (OR = 1.99, 95% CI = 1.52–2.60, p < 0.05; ORs = 2.50, 95% CI = 1.70–3.68, p < 0.05). We found no statistically significant differences in P-wave amplitude or dispersion. Conclusion: Prolonged P-wave duration and the presence of interatrial block were associated with the incidence of NOAF. Larger prospective studies are needed to confirm these findings.
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Emmanuela et al. (2026) conducted a meta-analysis in New-onset atrial fibrillation (NOAF) (n=4,331). Advanced interatrial block and prolonged P-wave duration on ECG vs. Normal P-wave morphology / absence of interatrial block was evaluated on New-onset atrial fibrillation (NOAF) occurrence (OR 2.50, 95% CI 1.70-3.68, p=<0.05). Advanced interatrial block (OR 2.50), partial interatrial block (OR 1.99), and longer P-wave duration (SMD 0.29) were significantly associated with new-onset atrial fibrillation.
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