P-wave duration and interatrial block as predictors of new-onset atrial fibrillation: A systematic review and meta-analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background 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. Methods 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). Results 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. Conclusion 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.