P-terminal force in lead V1: May the force be with you

A routine clinical 12-lead electrocardiogram (ECG) is a ubiquitous, inexpensive, noninvasive, and widely available diagnostic and prognostic tool. Over the century of scientific investigation and clinical practice, a large body of knowledge has been accumulated about the underlying mechanisms and diagnostic and prognostic value of P-wave appearance on the ECG. A recent comprehensive review endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology highlighted important P-wave parameters and indices: interatrial block, P-wave terminal force in lead V1 (PTFV1), P-wave duration, voltage, axis, and area. 1 Chen L.Y. Ribeiro A.L.P. Platonov P.G. et al. P wave parameters and indices: a critical appraisal of clinical utility, challenges, and future research—a consensus document endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology. Circ Arrhythm Electrophysiol. 2022; 15e010435 Google Scholar Multiple prospective observational studies demonstrated the associations of P-wave indices with incident atrial fibrillation, stroke, dementia, cardiovascular, and sudden cardiac death. 1 Chen L.Y. Ribeiro A.L.P. Platonov P.G. et al. P wave parameters and indices: a critical appraisal of clinical utility, challenges, and future research—a consensus document endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology. Circ Arrhythm Electrophysiol. 2022; 15e010435 Google Scholar , 2 Tereshchenko L.G. Henrikson C.A. Sotoodehnia N. et al. Electrocardiographic deep terminal negativity of the P wave in V1 and risk of sudden cardiac death: the Atherosclerosis Risk in Communities (ARIC) study. J Am Heart Assoc. 2014; 3e001387 Crossref PubMed Scopus (45) Google Scholar , 3 Tereshchenko L.G. Shah A.J. Li Y. Soliman E.Z. Electrocardiographic deep terminal negativity of the P wave in V1 and risk of mortality: the National Health and Nutrition Examination Survey III. J Cardiovasc Electrophysiol. 2014; 25: 1242-1248 Crossref PubMed Scopus (32) Google Scholar Additionally, advanced interatrial block, abnormal P-wave duration, axis, and PTFV1 showed a C-statistic of 0.65–0.78 for the prediction of these clinical outcomes. 1 Chen L.Y. Ribeiro A.L.P. Platonov P.G. et al. P wave parameters and indices: a critical appraisal of clinical utility, challenges, and future research—a consensus document endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology. Circ Arrhythm Electrophysiol. 2022; 15e010435 Google Scholar Electrocardiographic P terminal force in lead V1, its components, and the association with stroke and atrial fibrillation or flutterHeart RhythmVol. 20Issue 3PreviewThe electrocardiographic (ECG) marker P terminal force V1 (PTFV1) is generally perceived as a marker of left atrial pathology and has been associated with atrial fibrillation or flutter (AF). Full-Text PDF