Novel electrocardiographic classification for stroke prediction in atrial fibrillation patients undergoing cardioversion




Relander, Arto; Ruohonen, Ilkka; Jaakkola, Samuli; Vasankari, Tuija; Nuotio, Ilpo; Airaksinen, Juhani; Kiviniemi, Tuomas

PublisherElsevier

2024

Heart Rhythm

Heart Rhythm

21

12

2407

2418

1547-5271

1556-3871

DOIhttps://doi.org/10.1016/j.hrthm.2024.04.083

https://doi.org/10.1016/j.hrthm.2024.04.083

https://research.utu.fi/converis/portal/detail/Publication/393350570



Background: Abnormal conduction, structure, and function of the atrial myocardium predispose to atrial fibrillation (AF) and stroke. The usefulness of electrocardiographic indices in predicting stroke or systemic embolism (SSE) in patients undergoing cardioversion (CV) for AF remains unknown, especially in those at low estimated risk.

Objective: We systematically evaluated the performance of various P-wave abnormalities (PWAs) in predicting SSE 30 days after CV (derivation cohort) and in the long term (validation cohort).

Methods: Electrocardiograms (n = 1773) of AF patients undergoing an acute CV were manually reviewed. The 30-day post-CV data were used to derive a composite PWA variable. The electrocardiographic findings were validated by the long-term follow-up of patients with no anticoagulation. Electrocardiograms of 27 CAREBANK study patients with right atrial appendage biopsies were further analyzed for histopathologic validation.

Results: During data derivation, the best performance was found with a combination of prolonged P-wave (≥180 ms), deflected P-wave morphology in lead II, biphasic P-waves in inferior leads, or increased P-terminal force (≥80 mm·ms) as markers for extensive PWA. In the validation cohort, 219 of 874 (25.1%) had extensive PWA. During a median follow-up of 4.9 years, there were 51 patients (5.8%) with SSE in total. In a competing risk model, PWA predicted SSE (adjusted hazard ratio, 2.1 per category; 95% CI, 1.4-3.1; P < .001). Areas under the curve for SSE at 3 years were 0.77, 0.79, and 0.86 for PWA, CHA2DS2-VASc, score, and their combination, respectively. On histologic evaluation, extensive PWA was associated with interstitial fibrosis (P = .033).

Conclusion: Novel electrocardiographic PWA classification provided additional prognostic insight in AF patients.


This work was supported by grants from the Finnish Medical Foundation, Finnish Foundation for Cardiovascular Research, State Research Funding by the Hospital District of Southwest Finland, and the Ida Montin Foundation. The funding sources had no role regarding study design and conduct including collection, management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript; or decision to submit the manuscript for publication.


Last updated on 2024-09-12 at 15:56