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Assessing Atrial Fibrillation Substrates by P Wave Analysis: A Comprehensive Review

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Abstract

Atrial fibrillation (AF) is the most common cardiac arrhythmia. Pharmacologic and non-pharmacologic rhythm control strategies impact on AF-related symptoms, while leaving largely unaffected the risk of stroke. Moreover, up to 20% of AF patients are asymptomatic during paroxysmal relapses of arrhythmia, thus underlying the need for early markers to identify at-risk patients and prevent cerebrovascular accidents. Indeed, non-invasive assessment of pre-clinical substrate changes that predispose to AF could provide early identification of at-risk patients and allow for tailored care paths. ECG-derived P wave analysis is a simple-to-use and inexpensive tool that has been successfully employed to detect AF-associated structural and functional atrial changes. Beyond standard electrocardiographic techniques, high resolution signal averaged electrocardiography (SAECG), by recording microvolt amplitude atrial signals, allows more accurate analysis of the P wave and possibly AF risk stratification. This review focuses on the evidence that support P wave analysis to assess AF substrates, predict arrhythmia relapses and guide rhythm-control interventions.

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  1. Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University, Rome, Via di Grottarossa 1035, 00189, Rome, Italy

    Francesca Palano, Carmen Adduci, Pietro Cosentino, Giacomo Silvetti, Francesca Boldini & Pietro Francia

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Palano, F., Adduci, C., Cosentino, P. et al. Assessing Atrial Fibrillation Substrates by P Wave Analysis: A Comprehensive Review. High Blood Press Cardiovasc Prev 27, 341–347 (2020). https://doi.org/10.1007/s40292-020-00390-1

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  • DOI: https://doi.org/10.1007/s40292-020-00390-1

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