Association Between P-Wave Duration, Dispersion, and Interatrial Block and Atrial High-Rate Episodes in CIED Patients

Introduction Atrial high-rate episodes (AHRE) have been linked to increased thromboembolic risk and all-cause mortality in patients with cardiac implantable electronic devices (CIEDs). Various predictors of AHRE development have been identified, emphasizing the need for close monitoring and the potential transition to clinical atrial fibrillation (AF). However, the predictive value of P wave characteristics on AHRE development remains conflicting. This meta-analysis aims to summarize existing data to investigate this association. Method We examined studies from MEDLINE and EMBASE databases up to May 2024 to investigate the association of baseline P-wave duration (PWD), P-wave dispersion (PWDIS), and interatrial block (IAB) with the risk of developing AHRE. We extracted the mean and standard deviations of PWD and PWDIS to calculate the pooled mean difference (MD). Risk ratios (RR) and 95% confidence intervals (CIs) were used to assess the association between IAB and AHRE risk, using the generic inverse variance method for combination. Results The meta-analysis included nine studies. Patients with AHRE had longer PWD and PWDIS compared to those without AHRE, with a pooled MD for PWD of 9.17 ms (95% CI: 4.74-13.60; I2 = 47%, p < 0.001) and a pooled MD for PWDIS of 20.56 ms (95% CI: 11.57-29.56; I2 = 57%, p < 0.001). Additionally, patients with IAB had a higher risk of developing AHRE, with a pooled RR of 3.33 (95% CI: 2.53-4.38; I2 = 0%, p < 0.001), compared to those without IAB. Conclusions Our meta-analysis found that patients with AHRE had higher PWD and PWDIS than those without AHRE. Additionally, IAB was associated with a higher risk of developing AHRE. These findings emphasize the importance of close monitoring and risk stratification, particularly for patients with P wave abnormalities.