Do P-Wave Indices Manifest Atrial Fibrillation after Postoperative Atrial Fibrillation?

Thank you for your interest in our research and for referencing the Morphology Voltage P-Wave Duration (MVP) score. This score integrates morphological features, voltage in lead I, and P-wave duration to stratify patients into low-, intermediate-, and high-risk categories for the development of atrial fibrillation (AF).[1] Previous studies have demonstrated its potential in predicting AF in patients following pulmonary vein isolation,[2] in postsurgical settings,[3] and within population-based cohorts.[4] In our recent study, we similarly evaluated these parameters and observed significant intergroup differences.[5]

We applied the MVP score to both our preoperative ECG dataset and our postoperative follow-up cohort. The preoperative data revealed a trend toward higher MVP scores in patients who later developed postoperative atrial fibrillation (POAF), as shown in [Fig. 1]. This tendency is further illustrated in [Fig. 2]. However, these differences did not reach statistical significance. To assess the predictive capacity of the MVP score for POAF in the preoperative setting, we conducted logistic regression analysis. This revealed a low predictive value with a small effect size (estimate: 12.5%; OR = 1.12) and a non-significant p-value (p = 0.446). The corresponding ROC curve yielded an AUC of 0.538, indicating limited utility of the MVP score for preoperative prediction of POAF in our dataset.

Fig. 1 Frequency of MVP score over subgroups in ECG presurgery, reflecting low risk (0–2), intermediate risk (3–4), and high risk (5–6) for atrial fibrillation, according to Alexander et al. (2019).[1] MVP, Morphology Voltage P-Wave Duration; POAF, postoperative atrial fibrillation group; SR, sinus rhythm group.

Fig. 2 Boxplot of MVP scores distribution across both subgroups presurgery. MVP, Morphology Voltage P-Wave Duration; POAF, postoperative atrial fibrillation group; SR, sinus rhythm group.

In contrast, application of the MVP score to the ECGs obtained during follow-up revealed a significant difference between the groups, as shown in the bar chart ([Fig. 3]), which illustrates the percentage distribution of scores. We also identified a statistically significant difference in mean MVP scores between the groups, as depicted in the boxplot ([Fig. 4]). These findings support our hypothesis that patients who experienced POAF are at an elevated long-term risk of developing AF.

Fig. 3 Frequency of MVP score over subgroups in ECG at follow-up, reflecting low risk (0–2), intermediate risk (3–4), and high risk (5–6) for atrial fibrillation, according to Alexander et al. (2019).[1] MVP, Morphology Voltage P-Wave Duration; POAF, postoperative atrial fibrillation group; SR, sinus rhythm group.

Fig. 4 Boxplot of MVP score distribution across both subgroups at follow-up. MVP, Morphology Voltage P-Wave Duration; POAF, postoperative atrial fibrillation group; SR, sinus rhythm group.

Furthermore, in a small subgroup of the follow-up cohort, episodes of paroxysmal AF were documented. To explore a potential linear relationship between elevated MVP scores and subsequent AF occurrence, we performed logistic regression analysis within the follow-up cohort. Once again, this analysis yielded a low predictive value (estimate: 16.8%; OR = 1.18), a non-significant p-value (p = 0.51), and an AUC of 0.461. Given the previously reported efficacy of the MVP score in post-coronary artery bypass graft patients,[3] we hypothesize that the lack of statistical significance in our study may be attributed to limited sample size and a small number of documented AF events.

Nonetheless, the consistent difference in mean MVP scores between groups reinforces our assumption that patients who develop POAF may be more susceptible to future AF episodes. These results contribute to the ongoing validation efforts of the MVP score. We advocate for further investigation in larger, multicenter studies to establish the score's full predictive utility. We remain optimistic that the MVP score could serve as a broadly applicable clinical tool for AF risk stratification.

Once again, we appreciate your engagement with our work and are pleased to share these additional insights from our dataset.

Publication History

Article published online:
31 July 2025

• References

• 1 Alexander B, Milden J, Hazim B. et al. New electrocardiographic score for the prediction of atrial fibrillation: The MVP ECG risk score (morphology-voltage-P-wave duration). Ann Noninvasive Electrocardiol 2019; 24 (06) e12669
• 2 Yang N, Yan N, Cong G, Yang Z, Wang M, Jia S. Usefulness of Morphology-Voltage-P-wave duration (MVP) score as a predictor of atrial fibrillation recurrence after pulmonary vein isolation. Ann Noninvasive Electrocardiol 2020; 25 (06) e12773
• 3 Erturk O, Hayıroglu MI, Karaagac A. et al. Efficacy of atrial fibrillation predictors including MVP ECG risk score compared between single or bilateral internal thoracic artery use. J Cardiothorac Surg 2024; 19 (01) 479
• 4 Baturova MA, Cornefjord G, Carlson J, Johnson LSB, Smith JG, Platonov PG. P-wave characteristics as electrocardiographic markers of atrial abnormality in prediction of incident atrial fibrillation - The Malmö Preventive Project. J Electrocardiol 2024; 82: 125-130
• 5 Rau C, Salzmann-Djufri M, Böning A, Rohrbach S, Niemann B. Do P-wave indices manifest atrial fibrillation after postoperative atrial fibrillation?. Thorac Cardiovasc Surg 2025; ( E-pub ahead of print).