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Novel electrocardiography parameter for paroxysmal atrial fibrillation in acute ischaemic stroke patients: P wave peak time
  1. Ahmet Öz1,
  2. Tufan Cinar2,
  3. Cansu Kızılto Güler3,
  4. Süleyman Çağan Efe,
  5. Ufuk Emre3,
  6. Turgut Karabağ1,
  7. Burak Ayça1
  1. 1 Cardiology, Istanbul Teaching and Research Hospital, Istanbul, Turkey
  2. 2 Cardiology, Sultan 2. Abdulhamid Han Teaching and Research Hospital, Istanbul, Turkey
  3. 3 Neurology, Istanbul Teaching and Research Hospital, Istanbul, Turkey
  1. Correspondence to Dr Ahmet Öz, Department of Cardiology, Istanbul Teaching and Research Hospital, Samatya, 34098, İstanbul, Turkey; drozahmet{at}


Introduction In this study, we aimed to investigate the usefulness of P wave peak time (PWPT), a novel ECG parameter, in patients who were diagnosed with acute ischaemic stroke (IS) and had paroxysmal atrial fibrillation (PAF) on Holter monitoring.

Materials and methods In this retrospective cohort study, we included 90 consecutive patients with acute IS who were admitted to our hospital between January 2017 and July 2019. PWPT was described as the time from the beginning of the P wave to its peak, and it was measured from leads DII and VI. The PAF diagnosis was confirmed if it was detected on the ECG during palpitation or in rhythm during the Holter recordings.

Results In this study, 34 (37.7%) patients with acute IS were diagnosed with PAF. In multivariate analyses, the independent predictors of PAF were age, PWPT in lead VI and PWPT in lead DII (OR: 1.34, 95% CI 1.15 to 1.56; p<0.001). A receiver operating curve analysis demonstrated that area under the curve values for PWPT in lead DII for PAF were 0.88 (95% CI 0.81 to 0.95, p<0.001). The cut-off value for PWPT in lead DII in predicting PAF was 68.5 ms with a sensitivity of 82.4% and a specificity of 75.0%.

Conclusion To the best of our knowledge, this is the first study to demonstrate a significant relationship between PWPT in lead DII and PAF among patients with acute IS.

  • adult cardiology
  • stroke medicine

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  • Contributors AÖ and TC planned the study. AÖ, CKG, SÇE and UE collected the data. AÖ, TC and SÇE analysed the data. AÖ and TC performed the literature search and wrote the paper. TK and BA made the critical revision of the papaer. All authors have contributed significantly to the manuscript to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Institutional Ethics Committee and conducted in accordance with the Good Clinical Practice guidelines of the Declaration of Helsinki (approval number: 2013).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.