Key result
Higher lead I P-wave voltage linked to ~30% lower odds of atrial myxoma per 0.01 mV.
Why the study?
Atrial myxoma is the most common primary cardiac neoplasm, but whether electrocardiographic P-wave indices carry diagnostic information for detecting atrial myxomas had not been systematically examined.
Do standard 12-lead ECG P-wave indices differ between patients with atrial myxoma and matched controls and independently predict tumor presence?
Cohort (n=83)
No
Do standard 12-lead ECG P-wave indices differ between patients with atrial myxoma and matched controls and independently predict tumor presence?
Answers are grounded in this paper and cite their sources.
Reduced P-wave voltage in lead I and shorter P-wave duration on standard 12-lead ECG are associated with atrial myxomas and may serve as a low-cost diagnostic adjunct to prompt cardiac imaging.
Background Atrial myxoma is the most common primary cardiac neoplasm, which may cause embolisms, obstruction, and arrhythmias. Whether electrocardiographic P-wave indices carry diagnostic information for detecting atrial myxomas has not been systematically examined. Methods We retrospectively analyzed 83 patients: 39 with histologically confirmed atrial myxoma (34 left, 5 right atrial) and 44 age- and sex-matched controls. Seven P-wave indices were derived from 12-lead ECGs: duration, morphology in V1, voltage in lead I, axis, area in lead II, morphology-voltage-P-wave duration (MVP) score and dispersion. Logistic regression was used to identify possible predictors for atrial myxoma, with adjustment for age, sex, coronary artery disease, dyslipidemia, and smoking. Results Patients’ median age was 60.0 [51.0–70.0] years; 77.1% were women. Atrial myxoma had a median size of 4.1 cm [IQR 2.5; 5.6]. Patients with a myxoma showed shorter P-wave duration (100 [80; 100] vs. 100 [100; 120] ms; p = 0.005) and lower lead-I voltage (0.07 [0.05; 0.08] vs. 0.09 [0.06; 0.10] mV; p < 0.001). On univariable analysis, both predicted tumor presence. Entered together, only voltage remained independently (OR 0.76 per 0.01 mV, 95% CI 0.63–0.91, p = 0.003) associated with atrial myxoma; duration became borderline due to collinearity ( p = 0.078). After full adjustment, voltage remained robust (OR 0.70, 95% CI 0.55–0.89, p = 0.004). Within the tumor group, a larger maximal tumor diameter was associated with lower lead-I voltage (Spearman ρ = − 0.32; p = 0.044). Conclusions ECG analysis of patients with atrial myxoma revealed reduced P-wave voltage in lead I, with relatively short P-wave duration. Reduced P-wave voltage in lead I was an independent predictor after full adjustment for cardiovascular comorbidities and may serve as a novel, easily available diagnostic adjunct for atrial mass lesions.
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Doldi et al. (2026) conducted a cohort in Atrial myxoma (n=83). P-wave voltage in lead I (per 0.01 mV) on 12-lead ECG vs. Age- and sex-matched controls without atrial myxoma was evaluated on Presence of histologically confirmed atrial myxoma (fully adjusted multivariable logistic regression for P-wave voltage in lead I per 0.01 mV) (OR 0.70, 95% CI 0.55-0.89, p=0.004). Reduced P-wave voltage in lead I independently predicted the presence of atrial myxoma (adjusted OR 0.70 per 0.01 mV, 95% CI 0.55-0.89, p=0.004).
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