Electrocardiographic P-wave morphology and the risk of new-onset atrial fibrillation: a systematic review and meta-analysis

Introduction: Atrial fibrillation (AF) is linked to substantial morbidity and mortality due to its association with stroke and embolism. Early identification is difficult because AF is often asymptomatic. Electrocardiographic (ECG) features, particularly P-wave morphology, have been proposed as predictors of AF. However, previous findings remain inconsistent. This study evaluates the association between P-wave morphology and new-onset atrial fibrillation (NOAF). Material and methods: Data were retrieved from PubMed, ScienceDirect, Cochrane Library, ProQuest, and Sage Journal. Eligible studies used cohort or case-control designs involving NOAF populations and reported ECG parameters of P-wave morphology. The end-point was NOAF occurrence. Outcomes were expressed as odds ratios (ORs) for categorical variables and standardized mean differences (SMDs) for continuous variables, each with 95% confidence intervals (CI). Results: Ten cohort studies (854 NOAF and 3477 non-NOAF patients) were included. Patients who developed NOAF had significantly longer P-wave duration than those who did not (SMD = 0.29, 95% CI = 0.17-0.41, p < 0.05). Both partial and advanced interatrial blocks were significantly associated with NOAF (OR = 1.99, 95% CI = 1.52–2.60, p < 0.05; ORs = 2.50, 95% CI = 1.70–3.68, p < 0.05). We found no statistically significant differences in P-wave amplitude or dispersion. Conclusion: Prolonged P-wave duration and the presence of interatrial block were associated with the incidence of NOAF. Larger prospective studies are needed to confirm these findings.