Journal of arrhythmia · 2025
Newly Diagnosed Atrial Fibrillation Indicators in Cryptogenic Stroke Survivors' P-Wave Indices: A Systematic Review and Meta-Analysis.
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Balweel Haikal, Immanuel Surya Sinaga, Budiono Jordan, Rinaldi Fransiskus Xaverius, Sayogo Yeziel, Tafriend Novaro Adeneur, Harsoyo Agus
Аннотация
BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia and a major cause of ischemic stroke recurrence. Cryptogenic stroke (CS) survivors face a higher risk for newly diagnosed AF (NDAF), with subtle ECG markers-prolonged P-wave duration (PWDur) and increased P-wave dispersion (PWDis)-potentially serving as early indicators. We aimed to quantify baseline PWDur and PWDis differences between CS survivors with NDAF and those in sinus rhythm.
METHODS: Following PRISMA guidelines, we systematically searched nine databases through January 2025 for observational studies assessing baseline P-wave indices in adult CS patients in sinus rhythm. Data extraction and risk of bias assessment using the ROBINS-E tool were performed independently. Pooled mean differences (MD) with 95% confidence intervals (CI) were calculated using a random-effects inverse-variance model. Subgroup/sensitivity analyses were conducted by age groups, male proportion, region, follow-up duration, percentage of comorbidities, AF definition and detection methods, and ECG parameter. Heterogeneity was assessed using Cochran's Q, τ 2, and I 2 and interpreted using Cochrane thresholds; certainty was appraised with GRADE.
RESULTS: Ten studies, encompassing 1508 patients (mean age 66.72 ± 13.74 years; 55.7% male), met the inclusion criteria. Baseline PWDur was longer in the NDAF (MD 6.36 ms, 95% CI: 0.69-12.03, p = 0.03, I 2 = 73%, GRADE: moderate). Sensitivity analysis confirmed the robustness. PWDis remained non-significant.
CONCLUSION: Prolonged baseline PWDur may serve as a non-invasive marker of atrial conduction abnormalities and a predictor of AF in CS survivors. Larger prospective studies are needed to validate its role in risk stratification and secondary stroke prevention.
TRIAL REGISTRATION: PROSPERO: CRD42025646135.
METHODS: Following PRISMA guidelines, we systematically searched nine databases through January 2025 for observational studies assessing baseline P-wave indices in adult CS patients in sinus rhythm. Data extraction and risk of bias assessment using the ROBINS-E tool were performed independently. Pooled mean differences (MD) with 95% confidence intervals (CI) were calculated using a random-effects inverse-variance model. Subgroup/sensitivity analyses were conducted by age groups, male proportion, region, follow-up duration, percentage of comorbidities, AF definition and detection methods, and ECG parameter. Heterogeneity was assessed using Cochran's Q, τ 2, and I 2 and interpreted using Cochrane thresholds; certainty was appraised with GRADE.
RESULTS: Ten studies, encompassing 1508 patients (mean age 66.72 ± 13.74 years; 55.7% male), met the inclusion criteria. Baseline PWDur was longer in the NDAF (MD 6.36 ms, 95% CI: 0.69-12.03, p = 0.03, I 2 = 73%, GRADE: moderate). Sensitivity analysis confirmed the robustness. PWDis remained non-significant.
CONCLUSION: Prolonged baseline PWDur may serve as a non-invasive marker of atrial conduction abnormalities and a predictor of AF in CS survivors. Larger prospective studies are needed to validate its role in risk stratification and secondary stroke prevention.
TRIAL REGISTRATION: PROSPERO: CRD42025646135.