Sinus Rhythm P-wave Phenotyping for Identifying La-tent Atrial Fibrillation Substrate in Veteran Endurance Athletes

Fan Feng, Cai Lloyd Davies, Ekenedirichukwu Nelson Obianom, Abdulhamed Mohammed Jasim, Abdulmalik Koya, Shamsu Idris Abdullahi, Noor Qaqos, Xin Li, G. Andre Ng
University of Leicester


Abstract

Atrial fibrillation (AF)-related remodelling may persist during sinus rhythm (SR) and manifest as subtle P-wave abnormalities. This study investigated whether P-wave phenotypes from SR electrocardiograms can distinguish veteran endurance athletes withprevious AF from athletes without AF history. Twenty-three male athletes with prior AF (AF-SR; 56.30 ± 5.63 years) and 20 male controls (SR-SR; 56.55 ± 5.25 years) underwent 10-min resting 12-lead ECG at 180 Hz. A representative 10-s segment was analysed per participant; 328 P-waves were manually annotated using V3 as the reference lead, and patient-level phenotypes were derived. AF-SR athletes showed greater P-wave area variability (5.94 [5.24-6.34] vs 4.14 [3.80-4.73] mV·ms, p < 0.0001), energy variability (0.20 [0.14-0.22] vs 0.10 [0.085-0.13] mV², p = 0.001), amplitude variability (0.035 [0.030-0.038] vs 0.024 [0.022-0.026] mV, p = 0.001), and biphasic index (0.13 [0.10-0.15] vs 0.09 [0.06-0.10], p = 0.002). Random forest achieved an AUC of 0.837 versus 0.815 for logistic regression. These findings support sinus-rhythm P-wave phenotyping as a non-invasive marker of latent AF-related atrial substrate in veteran endurance athletes.