Temporal alterations in P-wave electrocardiographic metrics post patent foramen ovale closure: a retrospective study

Aims: This study aimed to analyze the electrocardiograms (ECG) of 69 patients before and after patent foramen ovale (PFO) closure, specifically investigating novel ECG parameters, over a 6-month post-procedure period. Methods: ECGs from 69 patients undergoing PFO closure were examined at three time points: before the procedure, and at 1st and 6th months post-procedure. A comprehensive set of ECG parameters, including P-wave (PW) maximum (PWmax), PW minimum (PWmin), PR interval, PW dispersion (PWdis), PW peak time in lead D2 (PWPTD2), PW peak time in lead V1(PWPTV1), P-axis, PW terminal force in the V1 (PWTF) and heart rate, were analyzed using a generalized linear mixed model (GLMM). Results: The GLMM analysis revealed significant changes in novel ECG parameters at 1-month post-procedure compared to baseline values. Parameters including PWmax (OR=8.898, 95% CI 7.521-10.275, p<0.001, PWmin (OR=6.579, 95% CI 5.611-7.548, p<0.001), PR (OR=4.159,95% CI 3.031-5.288, p<0.001), PWdis (OR=2.594, 95% CI 1.607-3.581, p<0.001), PWPTD2 (OR=4.261, 95% CI 2.928-5.593, p<0.001), PWPTV1 (OR=5.261, 95% CI 4.529-5.992, p<0.001), and PWTF (OR= 5.781, 95% CI 2.083-16.044, p<0.001) exhibited notable alterations, indicating a transient impact on cardiac conduction. However, these changes returned to baseline values by the 6-month follow-up. No statistically significant differences were observed in P-axis and heart rate across all time points. Conclusion: The analysis of ECG in patients undergoing PFO closure highlighted dynamic changes in novel ECG parameters in the early post-procedural period, with subsequent normalization by 6 months. Further research is warranted to elucidate the clinical implications of these dynamic electrocardiographic shifts and their potential association with long-term cardiovascular outcomes.