P-wave duration in cryptogenic stroke: A case control prospective study

Cryptogenic stroke (CS) represents a challenge for secondary prevention. Identification of embolic markers in this population is crucial to identify patients at risk of cardioembolic stroke and recurrence. This study evaluates the P-wave duration (PWD) a non-fibrillatory atrial electrical marker in a population of patients with CS compared with a stroke-free control group. Patients between 18 and 80 years old who had implantable loop recorder inserted between January 2019 and April 2021 for CS workup were included. At the same time, a stroke-free control group was constituted with patients admitted to the department of cardiology for cardiac evaluation. The primary end point was PWD measured on a 12-lead electrocardiogram (ECG) with high amplification. P-wave amplitude and various echocardiographic parameters of atrial function were collected in all participants. Patients in the cryptogenic stroke group were monitored over time to detect atrial fibrillation (AF) occurrence or stroke recurrence. In all, 95 patients were included in the stroke group and 96 in the control group. PWD was significantly increased in patients in the stroke group compared with controls (133 ± 13 and 122 ± 15 ms respectively, P < 0.001). There was a linear relationship between PWD and left atrial (LA) surface in all patients (r = 0.43, P < 0.001). During follow-up, 12% of patients in the stroke group developed AF and 7 patients had recurrent stroke. There was no significant difference on any variable between those who developed AF or recurrent stroke and the others. Patients with recent and older ischemic lesions or in multiple territories had significantly prolonged P-wave duration compared with others (Fig. 1). PWD is increased in patients with cryptogenic stroke. PWD measured on a high-amplification ECG could be a new noninvasive indicator of cardioembolic risk and guide the antithrombotic strategy in this population.