# Newly Diagnosed Atrial Fibrillation Indicators in Cryptogenic Stroke Survivors' P‐Wave Indices: A Systematic Review and Meta‐Analysis

## TL;DR

This study finds that prolonged P-wave duration in ECGs of cryptogenic stroke survivors may indicate a higher risk of newly diagnosed atrial fibrillation.

## Contribution

The study identifies prolonged P-wave duration as a potential non-invasive marker for atrial conduction abnormalities in cryptogenic stroke survivors.

## Key findings

- Baseline P-wave duration was significantly longer in patients with newly diagnosed atrial fibrillation.
- P-wave dispersion did not show significant differences between groups.
- The findings suggest P-wave duration could aid in risk stratification for stroke recurrence.

## Abstract

Atrial fibrillation (AF) is the most common arrhythmia and a major cause of ischemic stroke recurrence. Cryptogenic stroke (CS) survivors face a higher risk for newly diagnosed AF (NDAF), with subtle ECG markers—prolonged P‐wave duration (PWDur) and increased P‐wave dispersion (PWDis)—potentially serving as early indicators. We aimed to quantify baseline PWDur and PWDis differences between CS survivors with NDAF and those in sinus rhythm.

Following PRISMA guidelines, we systematically searched nine databases through January 2025 for observational studies assessing baseline P‐wave indices in adult CS patients in sinus rhythm. Data extraction and risk of bias assessment using the ROBINS‐E tool were performed independently. Pooled mean differences (MD) with 95% confidence intervals (CI) were calculated using a random‐effects inverse‐variance model. Subgroup/sensitivity analyses were conducted by age groups, male proportion, region, follow‐up duration, percentage of comorbidities, AF definition and detection methods, and ECG parameter. Heterogeneity was assessed using Cochran's Q, τ
2, and I
2 and interpreted using Cochrane thresholds; certainty was appraised with GRADE.

Ten studies, encompassing 1508 patients (mean age 66.72 ± 13.74 years; 55.7% male), met the inclusion criteria. Baseline PWDur was longer in the NDAF (MD 6.36 ms, 95% CI: 0.69–12.03, p = 0.03, I
2 = 73%, GRADE: moderate). Sensitivity analysis confirmed the robustness. PWDis remained non‐significant.

Prolonged baseline PWDur may serve as a non‐invasive marker of atrial conduction abnormalities and a predictor of AF in CS survivors. Larger prospective studies are needed to validate its role in risk stratification and secondary stroke prevention.

PROSPERO: CRD42025646135

This study found that baseline P‐wave duration is significantly prolonged in cryptogenic stroke survivors with newly diagnosed atrial fibrillation, supporting its role as a non‐invasive marker of atrial conduction abnormality and a tool for risk stratification and secondary stroke prevention.