![]() ![]() ![]() The pathophysiological correlate for this relationship remains an area of active investigation. There have been several large cohort studies looking at the relationship between abnormal P-wave axis and detection of future incident AF, whilst there have also been smaller case-control studies considering specific patient sub-groups. Leftward deviation can be seen in left atrial enlargement as well as atrial conduction abnormalities. The former may be seen a variety of conditions, including right atrial enlargement, emphysema without right atrial enlargement and conduction abnormalities including ectopic atrial rhythms. An abnormal P-wave axis may either be right-wardly displaced, which is typically defined as > 75°, or left-wardly displaced, defined as <0°. The normal P-wave axis is defined by angles between 0° and 75°. The combination of significant morbidity and mortality associated with AF, combined with the safety profile of direct oral anticoagulants, has resulted in a drive to identify predictors of AF to optimise pharmacotherapy and minimise morbidity and mortality. More recently it has become a topic of interest with regards to its predictive potential for the detection of incident atrial fibrillation (AF). Its association with respiratory disease, and in particular emphysema, was previously well explored. The frontal P-wave axis reflects the dominant vector of atrial depolarisation, and can be calculated by analysis of the P-wave in the limb leads on a 12-lead electrocardiogram (ECG) with reference to the hexaxial system.
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