Zagoridis Konstantinos, Koutalas Emmanuel, Intzes Stergios, Symeonidou Marianthi, Zagoridou Nikoleta, Karagogos Konstantinos, Spanoudakis Emmanuel, Kanoupakis Emmanuel, Kochiadakis George, Dinov Borislav, Dagres Nikolaos, Hindricks Gerhard, Bollmann Andreas, Nedios Sotirios
Democritus University of Thrace, Medical School, Alexandroupoli, Greece.
Cardiology Department, Heraklion University Hospital, Crete, Greece.
Hellenic J Cardiol. 2023 Jul-Aug;72:57-64. doi: 10.1016/j.hjc.2023.03.007. Epub 2023 Apr 5.
Early detection of atrial fibrillation (AF) could improve patient outcomes. P-wave duration (PWD) and interatrial block (IAB) are known predictors of new-onset AF and could improve selection for AF screening. This meta-analysis reviews the published evidence and offers practical implications.
Publication databases were systematically searched, and studies reporting PWD and/or morphology at baseline and new-onset AF during follow-up were included. IAB was defined as partial (pIAB) if PWD≥120 ms or advanced (aIAB) if the P-wave was biphasic in the inferior leads. After quality assessment and data extraction, random-effects analysis calculated odds ratio (OR) and confidence intervals (CI). Subgroup analysis was performed for those with implantable devices (continuous monitoring).
Among 16,830 patients (13 studies, mean 66 years old), 2,521 (15%) had new-onset AF over a median of 44 months. New-onset AF was associated with a longer PWD (mean pooled difference: 11.5 ms, 13 studies, p < 0.001). The OR for new-onset AF was 2.05 (95% CI: 1.3-3.2) for pIAB (5 studies, p = 0.002) and 3.9 (95% CI: 2.6-5.8) for aIAB (7 studies, p < 0.001). Patients with pIAB and devices had higher AF-detection risk (OR: 2.33, p < 0.001) than those without devices (OR: 1.36, p = 0.56). Patients with aIAB had similarly high risk regardless of device presence. There was significant heterogeneity but no publication bias.
Interatrial block is an independent predictor of new-onset AF. The association is stronger for patients with implantable devices (close monitoring). Thus, PWD and IAB could be used as selection criteria for intensive screening, follow-up or interventions.
房颤（AF）的早期检测可改善患者预后。P波时限（PWD）和房间阻滞（IAB）是新发房颤的已知预测指标，可改善房颤筛查的选择。本荟萃分析回顾了已发表的证据并给出实际意义。
系统检索出版数据库，纳入报告基线时PWD和/或形态以及随访期间新发房颤的研究。若PWD≥120 ms，则IAB定义为不完全性（pIAB）；若下壁导联P波呈双相，则定义为完全性（aIAB）。经过质量评估和数据提取后，随机效应分析计算比值比（OR）和置信区间（CI）。对植入式设备（连续监测）的患者进行亚组分析。
在16830例患者（13项研究，平均年龄66岁）中，2521例（15%）在中位44个月时发生新发房颤。新发房颤与较长的PWD相关（平均合并差异：11.5 ms，13项研究，p<0.001）。pIAB（5项研究，p = 0.002）新发房颤的OR为2.05（95%CI：1.3 - 3.2），aIAB（7项研究，p<0.001）为3.9（95%CI：2.6 - 5.8）。有pIAB和设备的患者比没有设备的患者有更高的房颤检测风险（OR：2.33，p<0.001）（OR：1.36，p = 0.56）。无论是否有设备，aIAB患者的风险同样高。存在显著异质性但无发表偏倚。
房间阻滞是新发房颤的独立预测指标。对于植入式设备的患者（密切监测），这种关联更强。因此，PWD和IAB可作为强化筛查、随访或干预的选择标准。
