Key result
Interatrial conduction delay linked to ~92% higher incident AF risk in cryptogenic stroke or TIA.
Why the study?
Interatrial conduction delay is associated with AF and stroke risk, but the relationship between individual P-wave abnormalities and incident AF after cryptogenic stroke or TIA remained incompletely defined.
Do ECG markers of interatrial conduction delay (prolonged P-wave duration and biphasic inferior P-wave morphology) improve prediction of incident atrial fibrillation in patients with cryptogenic stroke or TIA undergoing continuous rhythm monitoring?
Cohort (n=357)
Do ECG markers of interatrial conduction delay (prolonged P-wave duration and biphasic inferior P-wave morphology) improve prediction of incident atrial fibrillation in patients with cryptogenic stroke or TIA undergoing continuous rhythm monitoring?
Simple ECG markers—specifically prolonged P-wave duration and biphasic inferior P-wave morphology—independently predict incident atrial fibrillation and improve risk stratification beyond clinical factors in patients with cryptogenic stroke or TIA.
Answers are grounded in this paper and cite their sources.
May refine AF risk stratification after cryptogenic stroke; leaves open whether ECG-guided monitoring improves outcomes.
Background Interatrial conduction delay (IACD) is associated with atrial fibrillation (AF) and stroke risk, but the relationship between individual P-wave abnormalities and incident AF after cryptogenic stroke/transient ischemic attack (TIA) remains incompletely defined. Objective To evaluate the association between individual P-wave abnormalities, IACD, and incident AF in patients with cryptogenic stroke/TIA undergoing continuous long-term rhythm monitoring. Methods Patients with cryptogenic stroke/TIA who underwent implantable loop recorder placement were stratified into normal conduction (NC; P-wave duration [PWD] <120 ms), partial delay (PD; PWD ≥120 ms), and advanced delay (AD; PWD ≥120 ms with biphasic inferior P-waves and superiorly directed terminal force). Individual P-wave parameters were evaluated for association with incident AF. Time-to-event analyses compared AF-free survival across groups, and multivariable models assessed predictors of incident AF. Results A total of 357 patients were included (NC 227, PD 82, AD 48), with a median follow-up of 477 days (IQR 235–803). AF was detected in 125 patients (35%) at a median of 58 days. Partial and advanced IACD were associated with shorter AF-free survival versus NC (adjusted HR 1.92, 95% CI 1.27–2.90; p=0.002). Prolonged PWD and biphasic inferior P-wave morphology independently predicted incident AF. Adding ECG markers improved discrimination beyond clinical risk factors (AUC 0.76 vs 0.70). Conclusion Prolonged PWD and biphasic inferior P-wave morphology independently predict incident AF and improve risk stratification after cryptogenic stroke/TIA. These simple ECG markers improve risk stratification beyond clinical factors and may help guide selection for targeted rhythm surveillance.
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Alkalbani et al. (2026) conducted a cohort in Cryptogenic stroke or transient ischemic attack (n=357). Partial or advanced interatrial conduction delay (P-wave duration ≥120 ms) vs. Normal conduction (P-wave duration <120 ms) was evaluated on Incident atrial fibrillation (adjusted HR 1.92, 95% CI 1.27-2.90, p=0.002). Partial and advanced interatrial conduction delay predicted incident AF vs normal conduction in cryptogenic stroke/TIA patients.
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