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, Lillehei Heart Institute & Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis' MN (L.Y.C.).
Antonio Luiz Ribeiro, Centro de Telessaúde, Hospital das Clínicas, & Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.P.R.).
Pyotr G. Platonov, Department of Cardiology, Clinical Sciences, Lund University, Lund' Sweden (P.G.P.).
Iwona Cygankiewicz, Department of Electrocardiology, Medical University of Lodz, Poland (I.C.).
Elsayed Z. Soliman, Institute of Global Health & Human Ecology, American University in Cairo, Cairo, Egypt (E.Z.S.).
Bulent Gorenek, Department of Cardiology, Eskişehir Osmangazi University, Eskisehir, Turkey (B.G.).
Takanori Ikeda, Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo' Japan (T.I.).
Vassilios P. Vassilikos, Third Cardiology Department, Hippokrateio General Hospital, Medical School, Aristotle University of Thessaloniki, Greece (V.P.V.).
Jonathan S. Steinberg, Clinical Cardiovascular Research Center, Univ of Rochester School of Medicine & Dentistry, Rochester, NY (J.S.S.).
Niraj Varma, Cardiac Electrophysiology, Heart & Vascular Institute, Cleveland Clinic, Cleveland' OH (N.V.).
Antoni Bayés-de-Luna, Cardiovascular Research Foundation. Cardiovascular ICCC-Program, Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain (A.B.-d.-L.).
Adrian Baranchuk, Division of Cardiology, Kingston Health Science, Center, Queen's University, Kingston, Ontario, Canada (A.B.).

Fifth Author's Department

Institute of Global Health & Human Ecology

Document Type

Research Article

Publication Title

Circulation. Arrhythmia and electrophysiology

Publication Date





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 V, 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.

First Page


Last Page