Norwich Medical School University of East Anglia, Norwich, United Kingdom.
Addenbrookes Hospital Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
PLoS One. 2022 Dec 1;17(12):e0278527. doi: 10.1371/journal.pone.0278527. eCollection 2022.
There is growing interest in the prediction of incident atrial fibrillation (AF). The 12-lead electrocardiogram (ECG) has been a particularly rich target for possible prediction strategies.
The P-wave axis is an ECG parameter that reflects the dominant vector of atrial depolarisation and is usually 0° -75°. There is a large body of literature suggesting that AF reflects structural and conduction abnormalities of the atria, and thus the P-wave axis may represent a sensitive parameter to detect such changes.
A systematic review and meta-analysis of published literature associating abnormal P-wave axis and the development of incident AF was performed. Electronic databases were systematically searched from inception to October 2021. A random-effects model with generic inverse variance weights was utilised to pool the most adjusted effect measure from each paper. A funnel plot was used to assess publication bias.
After excluding duplicate studies, 568 studies were screened. A total of eleven studies were identified that associated an abnormal P-wave axis with the subsequent detection of AF. The eight studies that considered abnormal P-wave axis as being <0° or >75° were pooled for meta-analysis. In the pooled studies a total of 78,222 patients were included with 5656 cases of incident atrial fibrillation identified. The meta-analysis of the studies suggested that an abnormal P-wave axis was associated with a pooled risk ratio of 2.12 (95% CI 1.49 to 3.01) for the detection of incident atrial fibrillation.
This comprehensive systematic review and meta-analysis, indicates the positive association of abnormal P wave axis and future detection of AF. Utilisation of abnormal P-wave axis, alongside other parameters, may allow clinicians to better risk-stratify individuals at increased risk of AF, and thus identify those who may benefit most from prolonged cardiac monitoring or targeted anticoagulation.
人们对预测心房颤动（AF）的兴趣日益浓厚。12 导联心电图（ECG）一直是可能的预测策略的特别丰富的目标。
P 波轴是心电图参数，反映了心房除极的主导向量，通常为 0°-75°。大量文献表明，AF 反映了心房的结构和传导异常，因此 P 波轴可能代表检测这些变化的敏感参数。
对与异常 P 波轴和新发 AF 相关的已发表文献进行了系统回顾和荟萃分析。从开始到 2021 年 10 月，系统地搜索了电子数据库。使用具有通用倒数方差权重的随机效应模型，从每篇论文中汇总最调整的效应量。使用漏斗图评估发表偏倚。
排除重复研究后，共筛选出 568 项研究。共确定了 11 项研究，这些研究将异常 P 波轴与随后检测到的 AF 相关联。将考虑异常 P 波轴<0°或>75°的 8 项研究进行荟萃分析。在汇总的研究中，共有 78222 名患者纳入，其中 5656 例确诊为新发心房颤动。研究的荟萃分析表明，异常 P 波轴与新发心房颤动的检测相关，汇总风险比为 2.12（95%置信区间 1.49 至 3.01）。
这项全面的系统评价和荟萃分析表明，异常 P 波轴与未来 AF 的检测呈正相关。异常 P 波轴与其他参数一起使用，可能使临床医生能够更好地对 AF 风险增加的个体进行风险分层，从而确定那些最有可能从延长心脏监测或靶向抗凝治疗中获益的个体。
