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Meta-Analysis
. 2023 Sep;8(3):712-721.
doi: 10.1177/23969873231172559. Epub 2023 May 2.

Predicting risk of AF in ischaemic stroke using sinus rhythm ECG abnormalities: A meta-analysis

Alexander Berry-Noronha  1 , Luke Bonavia  2 , Duncan Wilson  3 , Antti Eranti  4 , Maria Uggen Rasmussen  5 , Ahmad Sajadieh  5 , Fabienne Kreimer  6 , Michael Gotzmann  6 , Ramesh Sahathevan  7   8
Affiliations
Meta-Analysis

Predicting risk of AF in ischaemic stroke using sinus rhythm ECG abnormalities: A meta-analysis

Alexander Berry-Noronha et al. Eur Stroke J. 2023 Sep.

Abstract

Objective: To identify ECG changes in sinus rhythm that may be used to predict subsequent development of new AF.

Method: We identified prospective and retrospective cohort or case control studies evaluating ECG patterns from a 12-lead ECG in sinus rhythm taken in hospital or community predicting subsequent development of new AF. For each identified ECG predictor, we then identify absolute event rates and pooled risk ratios (RR) using an aggregate level random effects meta-analysis.

Results: We identified 609,496 patients from 22 studies. ECG patterns included P wave terminal force V1 (PTFV1), interatrial block (IAB) and advanced interatrial block (aIAB), abnormal P wave axis (aPWA), PR prolongation and atrial premature complexes (APCs). Pooled risk ratios reached significance for each of these; PTFV1 RR 1.48 (95% CI 1.04-2.10), IAB 2.54 (95% CI 1.64-3.93), aIAB 4.05 (95% CI 2.64-6.22), aPWA 1.89 (95% CI 1.25-2.85), PR prolongation 2.22 (95% CI 1.27-3.87) and APCs 3.71 (95% CI 2.23-6.16). Diabetes reduced the predictive value of PR prolongation.

Conclusion: APC and aIAB were most predictive of AF, while IAB, PR prolongation, PTFV1 and aPWA were also significantly associated with development of AF. These support their use in a screening tool to identify at risk cohorts who may benefit from further investigation, or following stroke, with empirical anticoagulation.

Keywords: ESUS; Stroke; atrial cardiopathy; atrial fibrillation; prevention.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Systematic review search strategy.
Figure 2.
Figure 2.
ECG abnormalities included in the study: (a) aIAB was defined as P-wave duration >120 ms with biphasic P-waves in leads II, III and aVF, (b) IAB was defined as P-wave duration >120 ms with one or more biphasic P-waves, (c) PTFV1 is the area of the negative deflection of the P-wave in lead V1 × duration of this negative deflection (abnormal >4000 µV × ms), (d) PR prolongation defined as >200 ms, (e) APC and (f) APWA defined as P-wave axis outside 0°–75°.
Figure 3.
Figure 3.
Pooled relative risks and forest plots: (a) aIAB, (b) IAB, (c) APCs, (d) aPWA, (e) PR prolongation and (f) PTFV1.
See this image and copyright information in PMC

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