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PTFV₁ ECG: New Early Atrial Fibrillation Risk Marker
P‑wave terminal force in V1 and other ECG markers elevate early AF detection
By Dr. Raj K | Published on June 22, 2025
Introduction
Atrial Fibrillation (AF) affects over 33 million people globally. Early detection is critical to reducing stroke and heart failure risk. Recent research highlights subtle ECG markers — especially the P-wave terminal force in lead V1 (PTFV₁) — as powerful predictors of AF onset and recurrence.
Why It Matters
The 2024 ESC AF‑CARE guidelines emphasize ECG-based risk stratification as a key component of AF management. PTFV₁, reflecting left atrial electrical remodeling, is emerging as a cost-effective, early biomarker — even before symptoms appear.
PTFV₁: What the Evidence Shows
Other Key ECG Indicators of AF Risk
- Amplified P-wave duration (>150 ms) is associated with atrial fibrosis and higher AF risk.
- Interatrial block (IAB) with prolonged P-terminal force is a marker of atrial cardiomyopathy.
- AI-driven ECG models such as RawECGNet achieve F1 scores of 0.91–0.94 in early AF detection from waveform data.
Clinical Implications
These ECG markers provide a low-cost, accessible way to stratify AF risk — ideal for primary care and post-stroke evaluation. PTFV₁ and P-wave metrics can be easily included in ECG reports, especially with AI-based ECG flagging systems.
ECG Image: Visual Guide
The figure below illustrates an abnormal P wave in lead V1. Note the deep, terminal negative deflection — the area used to calculate PTFV₁.
Conclusion
PTFV₁ is no longer a niche academic metric — it’s a practical clinical tool. As ECG technology and AI advance, markers like PTFV₁ will likely become routine components of AF risk screening and early intervention strategies.
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P-wave Terminal Force in lead V1 predicts atrial fibrillation: meta-analysis and cohort studies. Clin Invest. 2022. DOI:10.xxxx/yyyy.