Relationship between P-wave duration and the risk of atrial fibrillation

Introduction: P-wave duration (PWD) is an electrocardiographic (ECG) marker reflecting atrial conduction, and studies have shown that its prolongation is associated with atrial fibrillation. Areas covered: This review addresses the relationship between PWD and atrial fibrillation, how anatomic and physiologic changes in the atria potentiate the risk for atrial fibrillation, and how these atrial anatomic and physiologic changes relate to PWD. Other P-wave related entities, such as P-wave terminal force in V1, PR interval, and P wave axis are also addressed. Expert commentary: Atrial fibrillation is a manifestation of the underlying atrial disease. Fibrotic collagen deposition interrupts the electrical flow and thus can potentiate the transition from sinus rhythm to atrial fibrillation. PWD is an ECG parameter that provides insight into the intricacies of the atria and could be a useful marker for assessing the risk for atrial fibrillation. The main obstacle for broad utilization of PWD is that it is not routinely reported on the printout of the electrocardiogram.