P Wave Parameters and Indices: A Critical Appraisal of Clinical Utility, Challenges, and Future Research—A Consensus Document Endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology

Lin Yee Chen; Antonio Luiz Pinho Ribeiro; Pyotr G. Platonov; Iwona Cygankiewicz; Elsayed Z. Soliman; Bulent Gorenek; Takanori Ikeda; Vassilios P. Vassilikos; Jonathan S. Steinberg; Niraj Varma; Antoni Bayés-De-Luna; Adrian Baranchuk

doi:10.1161/CIRCEP.121.010435

P Wave Parameters and Indices: A Critical Appraisal of Clinical Utility, Challenges, and Future Research—A Consensus Document Endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology

Lin Yee Chen, Antonio Luiz Pinho Ribeiro, Pyotr G. Platonov, Iwona Cygankiewicz, Elsayed Z. Soliman, Bulent Gorenek, Takanori Ikeda, Vassilios P. Vassilikos, Jonathan S. Steinberg, Niraj Varma, Antoni Bayés-De-Luna, Adrian Baranchuk

Medicine - Cardiology Division

Research output: Contribution to journal › Review article › peer-review

75 Scopus citations

Abstract

Atrial cardiomyopathy, characterized by abnormalities in atrial structure and function, is associated with increased risk of adverse cardiovascular and neurocognitive outcomes, independent of atrial fibrillation. There exists a critical unmet need for a clinical tool that is cost-effective, easy to use, and that can diagnose atrial cardiomyopathy. P wave parameters (PWPs) reflect underlying atrial structure, size, and electrical activation; alterations in these factors manifest as abnormalities in PWPs that can be readily ascertained from a standard 12-lead ECG and potentially be used to aid clinical decision-making. PWPs include P wave duration, interatrial block, P wave terminal force in V₁, P wave axis, P wave voltage, P wave area, and P wave dispersion. PWPs can be combined to yield an index (P wave index), such as the morphology-voltage-P-wave duration ECG risk score. Abnormal PWPs have been shown in population-based cohort studies to be independently associated with higher risks of atrial fibrillation, ischemic stroke, sudden cardiac death, and dementia. Additionally, PWPs, either individually or in combination (as a P wave index), have been reported to enhance prediction of atrial fibrillation or ischemic stroke. To facilitate translation of PWPs to routine clinical practice, additional work is needed to standardize measurement of PWPs (eg, via semiautomated or automated measurement), confirm their reliability and predictive value, leverage novel approaches (eg, wavelet analysis of P waves and machine learning algorithms), and finally, define the risk-benefit ratio of specific interventions in high-risk individuals. Our ultimate goal is to repurpose the ubiquitous 12-lead ECG to advance the study, diagnosis, and treatment of atrial cardiomyopathy, thus overcoming critical challenges in prevention of cardiovascular disease and dementia.

Original language	English (US)
Pages (from-to)	E010435
Journal	Circulation: Arrhythmia and Electrophysiology
Volume	15
Issue number	4
DOIs	https://doi.org/10.1161/CIRCEP.121.010435
State	Published - Apr 1 2022

Bibliographical note

Funding Information:
We thank Dr Niki Oldenburg for her assistance in article preparation and submission. Dr Chen is supported by the USA National Institutes of Health (R01 HL141288, R01 HL126637, K24 HL155813); Dr Ribeiro is supported in part by CNPq (310679/2016-8 and 465518/2014-1) and by FAPEMIG (Fundação de Amparo à Pesquisa do Estado de Minas Gerais; PPM-00428-17 and RED-00081-16); Dr Platonov is supported by The Swedish Heart-Lung Foundation (grant no. 20200674) and by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF (Avtal för Läkarutbildning och klinisk Forskning)-agreement (grant no. 46702); Dr Vassilikos’s work on P-W wavelet analysis was partially supported by a Hellenic Cardiac Society Grant, ABdeLuna is supported by Foundation Jesus Serra (Autonomous University of Barcelona) and Foundation Daniel Bravo; Dr Steinberg is supported by USA National Institutes of Health (R34 HL133526 and R34 HL153579), Atricure, Inc, and AliveCor, Inc. Dr Soliman is supported the National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR001420).

Funding Information:
Dr Chen is supported by the USA National Institutes of Health (R01 HL141288, R01 HL126637, K24 HL155813); Dr Ribeiro is supported in part by CNPq (310679/2016-8 and 465518/2014-1) and by FAPEMIG (Fundação de Amparo à Pesquisa do Estado de Minas Gerais; PPM-00428-17 and RED-00081-16); Dr Platonov is supported by The Swedish Heart-Lung Foundation (grant no. 20200674) and by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF (Avtal för Läkarutbildning och klinisk Forskning)-agreement (grant no. 46702); Dr Vassilikos’s work on P-W wavelet analysis was partially supported by a Hellenic Cardiac Society Grant, ABdeLuna is supported by Foundation Jesus Serra (Autonomous University of Barcelona) and Foundation Daniel Bravo; Dr Steinberg is supported by USA National Institutes of Health (R34 HL133526 and R34 HL153579), Atricure, Inc, and AliveCor, Inc. Dr Soliman is supported the National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR001420).

Publisher Copyright:
© 2022 American Heart Association, Inc.

Keywords

Atrial fibrillation
Cardiomyopathy
Cardiovascular disease
Interatrial block
Ischemic stroke

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Publisher link

10.1161/CIRCEP.121.010435

Find It

Find It at U of M Libraries

Fingerprint

Dive into the research topics of 'P Wave Parameters and Indices: A Critical Appraisal of Clinical Utility, Challenges, and Future Research—A Consensus Document Endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology'. Together they form a unique fingerprint.

Cite this

Chen, L. Y., Ribeiro, A. L. P., Platonov, P. G., Cygankiewicz, I., Soliman, E. Z., Gorenek, B., Ikeda, T., Vassilikos, V. P., Steinberg, J. S., Varma, N., Bayés-De-Luna, A., & Baranchuk, A. (2022). P Wave Parameters and Indices: A Critical Appraisal of Clinical Utility, Challenges, and Future Research—A Consensus Document Endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology. Circulation: Arrhythmia and Electrophysiology, 15(4), E010435. https://doi.org/10.1161/CIRCEP.121.010435

P Wave Parameters and Indices: A Critical Appraisal of Clinical Utility, Challenges, and Future Research—A Consensus Document Endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology. / Chen, Lin Yee; Ribeiro, Antonio Luiz Pinho; Platonov, Pyotr G. et al.
In: Circulation: Arrhythmia and Electrophysiology, Vol. 15, No. 4, 01.04.2022, p. E010435.

Research output: Contribution to journal › Review article › peer-review

Chen, LY, Ribeiro, ALP, Platonov, PG, Cygankiewicz, I, Soliman, EZ, Gorenek, B, Ikeda, T, Vassilikos, VP, Steinberg, JS, Varma, N, Bayés-De-Luna, A & Baranchuk, A 2022, 'P Wave Parameters and Indices: A Critical Appraisal of Clinical Utility, Challenges, and Future Research—A Consensus Document Endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology', Circulation: Arrhythmia and Electrophysiology, vol. 15, no. 4, pp. E010435. https://doi.org/10.1161/CIRCEP.121.010435

Chen LY, Ribeiro ALP, Platonov PG, Cygankiewicz I, Soliman EZ, Gorenek B et al. P Wave Parameters and Indices: A Critical Appraisal of Clinical Utility, Challenges, and Future Research—A Consensus Document Endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology. Circulation: Arrhythmia and Electrophysiology. 2022 Apr 1;15(4):E010435. doi: 10.1161/CIRCEP.121.010435

Chen, Lin Yee ; Ribeiro, Antonio Luiz Pinho ; Platonov, Pyotr G. et al. / P Wave Parameters and Indices : A Critical Appraisal of Clinical Utility, Challenges, and Future Research—A Consensus Document Endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology. In: Circulation: Arrhythmia and Electrophysiology. 2022 ; Vol. 15, No. 4. pp. E010435.

@article{42fcbbe039eb4fb4b323c34951d84bd3,

title = "P Wave Parameters and Indices: A Critical Appraisal of Clinical Utility, Challenges, and Future Research—A Consensus Document Endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology",

abstract = "Atrial cardiomyopathy, characterized by abnormalities in atrial structure and function, is associated with increased risk of adverse cardiovascular and neurocognitive outcomes, independent of atrial fibrillation. There exists a critical unmet need for a clinical tool that is cost-effective, easy to use, and that can diagnose atrial cardiomyopathy. P wave parameters (PWPs) reflect underlying atrial structure, size, and electrical activation; alterations in these factors manifest as abnormalities in PWPs that can be readily ascertained from a standard 12-lead ECG and potentially be used to aid clinical decision-making. PWPs include P wave duration, interatrial block, P wave terminal force in V1, P wave axis, P wave voltage, P wave area, and P wave dispersion. PWPs can be combined to yield an index (P wave index), such as the morphology-voltage-P-wave duration ECG risk score. Abnormal PWPs have been shown in population-based cohort studies to be independently associated with higher risks of atrial fibrillation, ischemic stroke, sudden cardiac death, and dementia. Additionally, PWPs, either individually or in combination (as a P wave index), have been reported to enhance prediction of atrial fibrillation or ischemic stroke. To facilitate translation of PWPs to routine clinical practice, additional work is needed to standardize measurement of PWPs (eg, via semiautomated or automated measurement), confirm their reliability and predictive value, leverage novel approaches (eg, wavelet analysis of P waves and machine learning algorithms), and finally, define the risk-benefit ratio of specific interventions in high-risk individuals. Our ultimate goal is to repurpose the ubiquitous 12-lead ECG to advance the study, diagnosis, and treatment of atrial cardiomyopathy, thus overcoming critical challenges in prevention of cardiovascular disease and dementia.",

keywords = "Atrial fibrillation, Cardiomyopathy, Cardiovascular disease, Interatrial block, Ischemic stroke",

author = "Chen, {Lin Yee} and Ribeiro, {Antonio Luiz Pinho} and Platonov, {Pyotr G.} and Iwona Cygankiewicz and Soliman, {Elsayed Z.} and Bulent Gorenek and Takanori Ikeda and Vassilikos, {Vassilios P.} and Steinberg, {Jonathan S.} and Niraj Varma and Antoni Bay{\'e}s-De-Luna and Adrian Baranchuk",

note = "Funding Information: We thank Dr Niki Oldenburg for her assistance in article preparation and submission. Dr Chen is supported by the USA National Institutes of Health (R01 HL141288, R01 HL126637, K24 HL155813); Dr Ribeiro is supported in part by CNPq (310679/2016-8 and 465518/2014-1) and by FAPEMIG (Funda{\c c}{\~a}o de Amparo {\`a} Pesquisa do Estado de Minas Gerais; PPM-00428-17 and RED-00081-16); Dr Platonov is supported by The Swedish Heart-Lung Foundation (grant no. 20200674) and by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF (Avtal f{\"o}r L{\"a}karutbildning och klinisk Forskning)-agreement (grant no. 46702); Dr Vassilikos{\textquoteright}s work on P-W wavelet analysis was partially supported by a Hellenic Cardiac Society Grant, ABdeLuna is supported by Foundation Jesus Serra (Autonomous University of Barcelona) and Foundation Daniel Bravo; Dr Steinberg is supported by USA National Institutes of Health (R34 HL133526 and R34 HL153579), Atricure, Inc, and AliveCor, Inc. Dr Soliman is supported the National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR001420). Funding Information: Dr Chen is supported by the USA National Institutes of Health (R01 HL141288, R01 HL126637, K24 HL155813); Dr Ribeiro is supported in part by CNPq (310679/2016-8 and 465518/2014-1) and by FAPEMIG (Funda{\c c}{\~a}o de Amparo {\`a} Pesquisa do Estado de Minas Gerais; PPM-00428-17 and RED-00081-16); Dr Platonov is supported by The Swedish Heart-Lung Foundation (grant no. 20200674) and by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF (Avtal f{\"o}r L{\"a}karutbildning och klinisk Forskning)-agreement (grant no. 46702); Dr Vassilikos{\textquoteright}s work on P-W wavelet analysis was partially supported by a Hellenic Cardiac Society Grant, ABdeLuna is supported by Foundation Jesus Serra (Autonomous University of Barcelona) and Foundation Daniel Bravo; Dr Steinberg is supported by USA National Institutes of Health (R34 HL133526 and R34 HL153579), Atricure, Inc, and AliveCor, Inc. Dr Soliman is supported the National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR001420). Publisher Copyright: {\textcopyright} 2022 American Heart Association, Inc.",

year = "2022",

month = apr,

day = "1",

doi = "10.1161/CIRCEP.121.010435",

language = "English (US)",

volume = "15",

pages = "E010435",

journal = "Circulation: Arrhythmia and Electrophysiology",

issn = "1941-3149",

publisher = "Lippincott Williams and Wilkins",

number = "4",

}

TY - JOUR

T1 - P Wave Parameters and Indices

T2 - A Critical Appraisal of Clinical Utility, Challenges, and Future Research—A Consensus Document Endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology

AU - Chen, Lin Yee

AU - Ribeiro, Antonio Luiz Pinho

AU - Platonov, Pyotr G.

AU - Cygankiewicz, Iwona

AU - Soliman, Elsayed Z.

AU - Gorenek, Bulent

AU - Ikeda, Takanori

AU - Vassilikos, Vassilios P.

AU - Steinberg, Jonathan S.

AU - Varma, Niraj

AU - Bayés-De-Luna, Antoni

AU - Baranchuk, Adrian

N1 - Funding Information: We thank Dr Niki Oldenburg for her assistance in article preparation and submission. Dr Chen is supported by the USA National Institutes of Health (R01 HL141288, R01 HL126637, K24 HL155813); Dr Ribeiro is supported in part by CNPq (310679/2016-8 and 465518/2014-1) and by FAPEMIG (Fundação de Amparo à Pesquisa do Estado de Minas Gerais; PPM-00428-17 and RED-00081-16); Dr Platonov is supported by The Swedish Heart-Lung Foundation (grant no. 20200674) and by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF (Avtal för Läkarutbildning och klinisk Forskning)-agreement (grant no. 46702); Dr Vassilikos’s work on P-W wavelet analysis was partially supported by a Hellenic Cardiac Society Grant, ABdeLuna is supported by Foundation Jesus Serra (Autonomous University of Barcelona) and Foundation Daniel Bravo; Dr Steinberg is supported by USA National Institutes of Health (R34 HL133526 and R34 HL153579), Atricure, Inc, and AliveCor, Inc. Dr Soliman is supported the National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR001420). Funding Information: Dr Chen is supported by the USA National Institutes of Health (R01 HL141288, R01 HL126637, K24 HL155813); Dr Ribeiro is supported in part by CNPq (310679/2016-8 and 465518/2014-1) and by FAPEMIG (Fundação de Amparo à Pesquisa do Estado de Minas Gerais; PPM-00428-17 and RED-00081-16); Dr Platonov is supported by The Swedish Heart-Lung Foundation (grant no. 20200674) and by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF (Avtal för Läkarutbildning och klinisk Forskning)-agreement (grant no. 46702); Dr Vassilikos’s work on P-W wavelet analysis was partially supported by a Hellenic Cardiac Society Grant, ABdeLuna is supported by Foundation Jesus Serra (Autonomous University of Barcelona) and Foundation Daniel Bravo; Dr Steinberg is supported by USA National Institutes of Health (R34 HL133526 and R34 HL153579), Atricure, Inc, and AliveCor, Inc. Dr Soliman is supported the National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR001420). Publisher Copyright: © 2022 American Heart Association, Inc.

PY - 2022/4/1

Y1 - 2022/4/1

N2 - Atrial cardiomyopathy, characterized by abnormalities in atrial structure and function, is associated with increased risk of adverse cardiovascular and neurocognitive outcomes, independent of atrial fibrillation. There exists a critical unmet need for a clinical tool that is cost-effective, easy to use, and that can diagnose atrial cardiomyopathy. P wave parameters (PWPs) reflect underlying atrial structure, size, and electrical activation; alterations in these factors manifest as abnormalities in PWPs that can be readily ascertained from a standard 12-lead ECG and potentially be used to aid clinical decision-making. PWPs include P wave duration, interatrial block, P wave terminal force in V1, P wave axis, P wave voltage, P wave area, and P wave dispersion. PWPs can be combined to yield an index (P wave index), such as the morphology-voltage-P-wave duration ECG risk score. Abnormal PWPs have been shown in population-based cohort studies to be independently associated with higher risks of atrial fibrillation, ischemic stroke, sudden cardiac death, and dementia. Additionally, PWPs, either individually or in combination (as a P wave index), have been reported to enhance prediction of atrial fibrillation or ischemic stroke. To facilitate translation of PWPs to routine clinical practice, additional work is needed to standardize measurement of PWPs (eg, via semiautomated or automated measurement), confirm their reliability and predictive value, leverage novel approaches (eg, wavelet analysis of P waves and machine learning algorithms), and finally, define the risk-benefit ratio of specific interventions in high-risk individuals. Our ultimate goal is to repurpose the ubiquitous 12-lead ECG to advance the study, diagnosis, and treatment of atrial cardiomyopathy, thus overcoming critical challenges in prevention of cardiovascular disease and dementia.

AB - Atrial cardiomyopathy, characterized by abnormalities in atrial structure and function, is associated with increased risk of adverse cardiovascular and neurocognitive outcomes, independent of atrial fibrillation. There exists a critical unmet need for a clinical tool that is cost-effective, easy to use, and that can diagnose atrial cardiomyopathy. P wave parameters (PWPs) reflect underlying atrial structure, size, and electrical activation; alterations in these factors manifest as abnormalities in PWPs that can be readily ascertained from a standard 12-lead ECG and potentially be used to aid clinical decision-making. PWPs include P wave duration, interatrial block, P wave terminal force in V1, P wave axis, P wave voltage, P wave area, and P wave dispersion. PWPs can be combined to yield an index (P wave index), such as the morphology-voltage-P-wave duration ECG risk score. Abnormal PWPs have been shown in population-based cohort studies to be independently associated with higher risks of atrial fibrillation, ischemic stroke, sudden cardiac death, and dementia. Additionally, PWPs, either individually or in combination (as a P wave index), have been reported to enhance prediction of atrial fibrillation or ischemic stroke. To facilitate translation of PWPs to routine clinical practice, additional work is needed to standardize measurement of PWPs (eg, via semiautomated or automated measurement), confirm their reliability and predictive value, leverage novel approaches (eg, wavelet analysis of P waves and machine learning algorithms), and finally, define the risk-benefit ratio of specific interventions in high-risk individuals. Our ultimate goal is to repurpose the ubiquitous 12-lead ECG to advance the study, diagnosis, and treatment of atrial cardiomyopathy, thus overcoming critical challenges in prevention of cardiovascular disease and dementia.

KW - Atrial fibrillation

KW - Cardiomyopathy

KW - Cardiovascular disease

KW - Interatrial block

KW - Ischemic stroke

UR - http://www.scopus.com/inward/record.url?scp=85128800370&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85128800370&partnerID=8YFLogxK

U2 - 10.1161/CIRCEP.121.010435

DO - 10.1161/CIRCEP.121.010435

M3 - Review article

C2 - 35333097

AN - SCOPUS:85128800370

SN - 1941-3149

VL - 15

SP - E010435

JO - Circulation: Arrhythmia and Electrophysiology

JF - Circulation: Arrhythmia and Electrophysiology

IS - 4

ER -

P Wave Parameters and Indices: A Critical Appraisal of Clinical Utility, Challenges, and Future Research—A Consensus Document Endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology

Abstract

Bibliographical note

Keywords

UN SDGs

Publisher link

Find It

Other files and links

Fingerprint

Cite this