[Atrial fibrillation screening-reading the P-wave].

Authors

Felix Wiedmann, Frederike Marie Weitkamp, Constanze Schmidt

Published in

Innere Medizin (Heidelberg, Germany). Oct 02, 2026. Epub Oct 02, 2026.

Abstract

Atrial fibrillation (AF) is frequently intermittent and may therefore remain undetected on a short resting electrocardiogram (ECG). At the same time, a sinus-rhythm ECG contains information on the underlying atrial substrate.
To review conventional and artificial intelligence (AI)-based ECG markers of an atrial risk phenotype and their potential role in targeted AF screening.
Narrative appraisal of current consensus and guideline documents and of clinical, electrophysiological, and population-based studies on P‑wave parameters, AI-ECG, and risk-adapted AF screening.
P‑wave duration, interatrial block, P‑wave terminal force in V1, and other parameters are associated with atrial remodelling and future AF. AI models additionally extract high-dimensional patterns from sinus-rhythm ECGs and can predict occult or future AF. Initial prospective data indicate that such risk signals can enrich the diagnostic yield of prolonged rhythm monitoring.
The most plausible current clinical application is risk-adapted selection for prolonged rhythm monitoring. A P-wave or AI-based risk score neither establishes a diagnosis of AF nor, by itself, constitutes an indication for treatment.

PMID:
42827193
Bibliographic data and abstract were imported from PubMed on 03 Oct 2026.

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