Association between P-wave index and left atrium/left atrial appendage thrombosis in patients with paroxysmal atrial fibrillation

WU Huan-ping; DING Qian; WANG Jing-hao; XING Xiao-fen; MU Sheng-mei; LI Feng; HAN Yu-chen; ZENG Hui-qing; LIANG Ye-qing; GUO Jun

doi:10.3969/j.issn.1672-5301.2025.01.002

Abstract：Objective To explore the correlation between P-wave index and left atrial/left atrial appendage thrombosis in patients with paroxysmal atrial fibrillation(AF).Methods A total of 103 patients with paroxysmal AF admitted and received transesophageal echocardiography in our hospital from January 2016 to March 2022 were retrospectively analyzed.Among them 31 patients with left atrium/left atrial appendage thrombosis were as the case group,and the other 72 patients without thrombosis were as the control group.The baseline clinical data,P-wave index,transesophageal echocardiography and ultrasonic cardiogram were recorded and compared.P wave time duration≤89 ms or>120 ms was defined as abnormal P-wave duration.The univariate regression analysis was used to analyze the correlation between P-wave index and left atrial/left atrial appendage thrombosis in the patients.The risk factors for thrombosis were combined with the CHA2DS2-VASc score to form a new scoring system.The predictive value was evaluated using the receiver operating characteristic curve.Results The patients in the case group were older,with larger left atrial diameter and a higher CHA2DS2-VASc score(P<0.05).The univariate regression analysis showed that age,left atrial diameter,CHA2DS2-VASc score,abnormal P-wave duration,maximum P-wave duration,minimum P-wave duration,P-wave dispersion,and P-wave terminal force in lead V1 were all the risk factors for thrombosis.The multivariate Logistic regression analysis showed that P-wave terminal force in lead V1 and abnormal P wave duration were the independent risk factors for left atrium/left atrial appendage thrombosis in patients with paroxysmal AF(OR=1.103,95%CI 1.033-1.178,P=0.003;OR=14.037,95%CI 1.600-123.150,P=0.007).The area under the receiver operating characteristic curve of P-wave terminal force in lead V1 predicting left atrium/left atrial appendage thrombosis was 0.855(95%CI 0.757-0.953,P<0.001).The sensitivity of P-wave terminal force in lead V1 to predict left atrium/left atrial appendage thrombosis was 87.1%,and the specificity was 87.5%.The best cutoff point was 28.26mm·ms.P-wave terminal force in lead V1 and abnormal P-wave duration were combined with CHA2DS2-VASc score to form CHA2DS2-VASc-P2-V score.The area under the receiver operating characteristic curve of CHA2DS2-VASc-P2-V score was greater than that of CHA2DS2-VASc score(0.826 vs.0.654,P<0.001).Conclusion P-wave terminal force in lead V1 and abnormal P wave time duration are the independent risk factors for left atrial/left atrial appendage thrombosis in patients with paroxysmal AF.The predictive value of the CHA2DS2-VASc-P2-V score for left atrium/left atrial appendage thrombosis may be better than the CHA2DS2-VASc score.