What does this research mean for the field?

In patients with atrial fibrillation, 38.9% progressed from normal P-wave to moderate P-wave abnormalities, while 15.8% progressed to extensive P-wave abnormalities before cardioversion. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

February 8, 2026

Prevalence and progression of P-wave abnormalities in patients with atrial fibrillation

Resultado clave

In 1316 AF patients, P-wave abnormalities progressed in 15.8-18.2% over time, with only 27.7% maintaining normal P-waves at follow-up, driven by age and CV diseases.

Puntos clave

The central aim is to analyze the prevalence and progression of P-wave abnormalities in patients with atrial fibrillation.
Analyzed 3 sinus rhythm ECGs of 1316 individuals undergoing cardioversion for acute atrial fibrillation
Categorized patients by severity of P-wave abnormalities based on defined indices
Performed Cox regression analysis to identify independent risk factors for PWA progression.
38.9% progressed from normal to moderate P-wave abnormalities pre- and index cardioversion
15.8% progressed to extensive P-wave abnormalities during the same period
At follow-up, 32.2% progressed to moderate and 18.2% to extensive P-wave abnormalities
27.7% had normal P-wave, 38.7% had moderate, and 33.5% had extensive P-wave abnormalities at the end of follow-up.

PICO estructurado

Población

1316 individuals undergoing index cardioversion for acute atrial fibrillation in the FinCV study

Resultado

Prevalence and progression of P-wave abnormalities (PWAs) evaluated in a series of 3 sinus rhythm ECGssurrogate

P-wave abnormalities are highly prevalent and progressive in patients with atrial fibrillation, with structural and clinical cardiovascular comorbidities driving their development.

Resultado numérico

Tasa de eventos absoluta: 0% vs 0%

Resumen

Abstract Background and purpose Various electrocardiographic (ECG) P-wave indices have been linked to cardiovascular comorbidities such as atrial fibrillation (AF) and stroke. This study evaluates the previously lacking information on the prevalence and progression of P-wave abnormalities (PWAs) as well as their risk factors in AF population. Methods The prevalence and progression of PWAs was analyzed in a series of 3 sinus rhythm ECGs in 1316 individuals undergoing the index cardioversion (CV) for acute AF in the FinCV study. Patients were categorized to extensive PWA if they had P-wave duration ≥180ms, P-terminal force ≥80mm*ms, advanced interatrial block (biphasic P-waves in inferior leads and P-wave duration ≥120ms) or deflected P-wave morphology, while moderate PWA consisted of P-wave duration 150-180ms or P-terminal force 40-80mm*ms. Results Between pre-CV and index CV ECGs, 133/342 (38.9%) and 54/342 (15.8%) patients progressed from normal P-wave to moderate and extensive PWAs, respectively. During the follow-up after index CV, the respective rates were 131/407 (32.2%) and 74/407 (18.2%). At the end of follow-up, prevalence for normal P-wave was 311/1121 (27.7%), while 434 (38.7%) patients had moderate PWA and 376 (33.5%) extensive PWA. Increasing age, heart failure, hypertension, vascular disease, history of previous AF episodes, high CV frequency, left ventricular hypertrophy and wide QRS complex in the ECG were independent risk factors for persistent or progressive PWA status in a Cox regression analysis. Conclusions The prevalence and rate of progression of PWA are high in this cohort of AF patients with development mainly driven by aging and chronic cardiovascular conditions.Visual abstract

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