Electrocardiographic Predictors of Atrial Fibrillation
Abstract
Atrial fibrillation is arguably the most common heart rhythm disorder with increasing incidence and prevalence recently. Atrial fibrillation significantly contributes to increased mortality especially through the onset/worsening of heart failure and the occurrence of cardioembolic stroke. Identifying markers that could indicate the installation of this arrhythmia in a specific patient would warrant closer monitoring, establishing a preventive antiarrhythmic treatment or even timely anticoagulant treatment. This article reviews the electrocardiographic indicators of atrial fibrillation installation presented in recent literature. The databases in which the search was made were PubMed, Scopus and Google Scholar. The search terms used were “atrial fibrillation”, “supraventricular arrhythmias”, “electrocardiographic predictors”, “interatrial block”, “atrial extrasystoles”, “P wave dispersion”, “left atrial enlargement”. Most recent and relevant papers were included.
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References
1. O’Neill J, Bounford K, Anstey A, D’Silva J, Clark L, Plein S, et al. P wave indices, heart rate variability and anthropometry in a healthy South Asian population. PLoS One [Internet]. 2019 [citado 28 Feb 2021];14(8):e0220662. Disponible en: https://doi.org/10.1371/journal.pone.0220662
2. Militaru C, Donoiu I, Ionescu DD. P wave signal-averaged ECG in normal population and in patients with converted atrial fibrillation. Ann Noninvasive Electrocardiol. 2011;16:351-6. https://doi.org/10.1111/j.1542-474x.2011.00462.x
3. Nattel S, Harada M. Atrial remodeling and atrial fibrillation: recent advances and translational perspectives. J Am Coll Cardiol. 2014;63(22):2335-45. https://doi.org/10.1016/j.jacc.2014.02.555
4. Igarashi T, Finet JE, Takeuchi A, Fujino Y, Strom M, Greener ID, et al. Connexin gene transfer preserves conduction velocity and prevents atrial fibrillation. Circulation. 2012;125(2):216-25. https://doi.org/10.1161/circulationaha.111.053272
5. Gollob MH, Jones DL, Krahn AD, Danis L, Gong XQ, Shao Q, et al. Somatic mutations in the connexin 40 gene (GJA5) in atrial fibrillation. N Engl J Med. 2006;354(25):2677-88. https://doi.org/10.1056/nejmoa052800
6. Zou R, Kneller J, Leon LJ, Nattel S. Substrate size as a determinant of fibrillatory activity maintenance in a mathematical model of canine atrium. Am J Physiol Heart Circ Physiol. 2005;289(3):1002-12. https://doi.org/10.1152/ajpheart.00252.2005
7. Verheule S, Tuyls E, Gharaviri A, Hulsmans S, van Hunnik A, Kuiper M, et al. Loss of continuity in the thin epicardial layer because of endomysial fibrosis increases the complexity of atrial fibrillatory conduction. Circ Arrhythm Electrophysiol. 2013;6(1):202-11. https://doi.org/10.1161/circep.112.975144
8. Workman AJ. Cardiac adrenergic control and atrial fibrillation. Naunyn Schmiedebergs Arch Pharmacol. 2010;381(3):235-49. https://doi.org/10.1007/s00210-009-0474-0
9. Bettoni M, Zimmermann M. Autonomic tone variations before the onset of paroxysmal atrial fibrillation. Circulation. 2002;105(23):2753-9. https://doi.org/10.1161/01.cir.0000018443.44005.d8
10. Magnani JW, Zhu L, Lopez F, Pencina MJ, Agarwal SK, Soliman EZ, et al. P-wave indices and atrial fibrillation: cross-cohort assessments from the Framingham Heart Study (FHS) and Atherosclerosis Risk in Communities (ARIC) study. Am Heart J. 2015;169(1):53-61. https://doi.org/10.1016/j.ahj.2014.10.009
11. Mugnai G, Chierchia GB, de Asmundis C, Juliá J, Conte G, Sieira-Moret J, et al. P-wave indices as predictors of atrial fibrillation recurrence after pulmonary vein isolation in normal left atrial size. J Cardiovasc Med (Hagerstown). 2016;17(3):194-200. https://doi.org/10.2459/jcm.0000000000000220
12. Caldwell J, Koppikar S, Barake W, Redfearn D, Michael K, Simpson C, et al. Prolonged P-wave duration is associated with atrial fibrillation recurrence after successful pulmonary vein isolation for paroxysmal atrial fibrillation. J Interv Card Electrophysiol. 2014;39(2):131-8. https://doi.org/10.1007/s10840-013-9851-1
13. He J, Tse G, Korantzopoulos P, Letsas KP, Ali-Hasan-Al-Saegh S, Kamel H, et al. P-Wave Indices and Risk of Ischemic Stroke: A Systematic Review and Meta-Analysis. Stroke. 2017;48(8):2066-72. https://doi.org/10.1161/strokeaha.117.017293
14. Conde D, Baranchuk A. Bloqueo interauricular como sustrato anatómico-eléctrico de arritmias supraventriculares: síndrome de Bayés. Arch Cardiol Mex. 2014;84(1):32-40. https://doi.org/10.1016/j.acmx.2013.10.004
15. Bayés de Luna A, Escobar-Robledo LA, Aristizabal D, Weir Restrepo D, Mendieta G, Massó van Roessel A, et al. Atypical advanced interatrial blocks: Definition and electrocardiographic recognition. J Electrocardiol. 2018;51(6):1091-3. https://doi.org/10.1016/j.jelectrocard.2018.09.004
16. Tse G, Wong CW, Gong M, Wong WT, Bazoukis G, Wong SH, et al. Predictive value of inter-atrial block for new onset or recurrent atrial fibrillation: A systematic review and meta-analysis. Int J Cardiol. 2018;250:152-6. https://doi.org/10.1016/j.ijcard.2017.09.176
17. Alexander B, Baranchuk A, Haseeb S, van Rooy H, Kuchtaruk A, Hopman W, et al. Interatrial block predicts atrial fibrillation in patients with carotid and coronary artery disease. J Thorac Dis. 2018;10(7):4328-34. https://doi.org/10.21037/jtd.2018.06.53
18. Chávez-González E, Donoiu I. Utility of P-Wave Dispersion in the Prediction of Atrial Fibrillation. Curr Health Sci J. 2017;43(1):5-11. https://doi.org/10.12865/chsj.43.01.01
19. Michelucci A, Bagliani G, Colella A, Pieragnoli P, Porciani MC, Gensini G, et al. P wave assessment: state of the art update. Card Electrophysiol Rev. 2002;6(3):215-20. https://doi.org/10.1023/a:1016368723033
20. Zimmer K, Przywara W, Zyśko D, Sławuta A, Gajek J. The nature of P-wave dispersion - A clinically useful parameter that does not exist. Int J Cardiol. 2016;212:59-60. https://doi.org/10.1016/j.ijcard.2016.03.031
21. Acampa M, Guideri F, Tassi R, Dello Buono D, Celli L, di Toro Mammarella L, et al. P wave dispersion in cryptogenic stroke: A risk factor for cardioembolism? Int J Cardiol. 2015;190:202-4. https://doi.org/10.1016/j.ijcard.2015.04.185
22. Lazzeroni D, Parati G, Bini M, Piazza P, Ugolotti PT, Camaiora U, et al. P-wave dispersion predicts atrial fibrillation following cardiac surgery. Int J Cardiol. 2016;203:131-3. https://doi.org/10.1016/j.ijcard.2015.10.143
23. Boriani G, Diemberger I, Biffi M, Camanini C, Valzania C, Corazza I, et al. P wave dispersion and short-term vs. late atrial fibrillation recurrences after cardioversion. Int J Cardiol. 2005;101(3):355-61. https://doi.org/10.1016/j.ijcard.2004.03.039
24. Nakatani Y, Sakamoto T, Yamaguchi Y, Tsujino Y, Kataoka N, Kinugawa K. Coefficient of variation of P-wave duration measured using an automated measurement system predicts recurrence of atrial fibrillation. J Electrocardiol. 2019;53:79-84. https://doi.org/10.1016/j.jelectrocard.2019.01.089
25. Perez MV, Dewey FE, Marcus R, Ashley EA, Al-Ahmad AA, Wang PJ, et al. Electrocardiographic predictors of atrial fibrillation. Am Heart J. 2009;158(4):622-8. https://doi.org/10.1016/j.ahj.2009.08.002
26. Wong JK, Lobato RL, Pinesett A, Maxwell BG, Mora-Mangano CT, Perez MV. P-wave characteristics on routine preoperative electrocardiogram improve prediction of new-onset postoperative atrial fibrillation in cardiac surgery. J Cardiothorac Vasc Anesth. 2014;28(6):1497-504. https://doi.org/10.1053/j.jvca.2014.04.034
27. Aizawa Y, Watanabe H, Okumura K. Electrocardiogram (ECG) for the Prediction of Incident Atrial Fibrillation: An Overview. J Atr Fibrillation [Internet]. 2017 [citado 14 Mar 2021];10(4):1724. Disponible en: https://doi.org/10.4022/jafib.1724
28. Maheshwari A, Norby FL, Soliman EZ, Koene RJ, Rooney MR, O'Neal WT, et al. Abnormal P-Wave Axis and Ischemic Stroke: The ARIC Study (Atherosclerosis Risk In Communities). Stroke. 2017;48(8):2060-5. https://doi.org/10.1161/strokeaha.117.017226
29. Platonov PG. P-wave morphology: underlying mechanisms and clinical implications. Ann Noninvasive Electrocardiol. 2012;17(3):161-9. https://doi.org/10.1111/j.1542-474x.2012.00534.x
30. Holmqvist F, Platonov PG, McNitt S, Polonsky S, Carlson J, Zareba W, et al. Abnormal P-wave morphology is a predictor of atrial fibrillation development and cardiac death in MADIT II patients. Ann Noninvasive Electrocardiol. 2010;15(1):63-72. https://doi.org/10.1111/j.1542-474x.2009.00341.x
31. Goda T, Sugiyama Y, Ohara N, Ikegami T, Watanabe K, Kobayashi J, et al. P-Wave Terminal Force in Lead V1 Predicts Paroxysmal Atrial Fibrillation in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis. 2017;26(9):1912-5. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.06.031
32. Ishida K, Hayashi H, Miyamoto A, Sugimoto Y, Ito M, Murakami Y, et al. P wave and the development of atrial fibrillation. Heart Rhythm. 2010;7(3):289-94. https://doi.org/10.1016/j.hrthm.2009.11.012
33. Weinsaft JW, Kochav JD, Kim J, Gurevich S, Volo SC, Afroz A, et al. P wave area for quantitative electrocardiographic assessment of left atrial remodeling. PLoS One [Internet]. 2014 [citado 14 Mar 2021];9(6):e99178. Disponible en: https://doi.org/10.1371/journal.pone.0099178
34. Park J, Kim TH, Lee JS, Park JK, Uhm JS, Joung B, et al. Prolonged PR interval predicts clinical recurrence of atrial fibrillation after catheter ablation. J Am Heart Assoc [Internet]. 2014 [citado 14 Mar 2021];3(5):e001277. Disponible en: https://doi.org/10.1161/jaha.114.001277
35. Nielsen JB, Kühl JT, Pietersen A, Graff C, Lind B, Struijk JJ, et al. P-wave duration and the risk of atrial fibrillation: Results from the Copenhagen ECG Study. Heart Rhythm. 2015;12(9):1887-95. https://doi.org/10.1016/j.hrthm.2015.04.026
36. Prasitlumkum N, Rattanawong P, Limpruttidham N, Kanitsoraphan C, Sirinvaravong N, Suppakitjanusant P, et al. Frequent premature atrial complexes as a predictor of atrial fibrillation: Systematic review and meta-analysis. J Electrocardiol. 2018;51(5):760-7. https://doi.org/10.1016/j.jelectrocard.2018.05.012
37. Mandyam MC, Soliman EZ, Heckbert SR, Vittinghoff E, Marcus GM. Long-term outcomes of left anterior fascicular block in the absence of overt cardiovascular disease. JAMA. 2013;309(15):1587-8. https://doi.org/10.1001/jama.2013.2729
38. Mandyam MC, Soliman EZ, Alonso A, Dewland TA, Heckbert SR, Vittinghoff E, et al. The QT interval and risk of incident atrial fibrillation. Heart Rhythm. 2013;10(10):1562-8. https://doi.org/10.1016/j.hrthm.2013.07.023
39. Nielsen JB, Graff C, Pietersen A, Lind B, Struijk JJ, Olesen MS, et al. J-shaped association between QTc interval duration and the risk of atrial fibrillation: results from the Copenhagen ECG study. J Am Coll Cardiol. 2013;61(25):2557-64. https://doi.org/10.1016/j.jacc.2013.03.032
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