Jonas B Nielsen1, Jørgen T Kühl2, Adrian Pietersen3, Claus Graff4, Bent Lind3, Johannes J Struijk4, Morten S Olesen5, Moritz F Sinner6, Troels N Bachmann5, Stig Haunsø7, Børge G Nordestgaard8, Patrick T Ellinor9, Jesper H Svendsen7, Klaus F Kofoed2, Lars Køber2, Anders G Holst5. 1. Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark; Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. Electronic address: jonas.bille.nielsen@gmail.com. 2. Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark. 3. Copenhagen General Practitioners' Laboratory, Copenhagen, Denmark. 4. Department of Health Science and Technology, Aalborg University, Aalborg, Denmark. 5. Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark; Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 6. Department of Medicine I, University Hospital Munich, Campus Grosshadern, Ludwig-Maximilians-University, Munich, Germany. 7. Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark; Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark. 8. Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Herlev, Denmark. 9. Cardiac Arrhythmia Service, Cardiovascular Research Center & Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts.
Abstract
BACKGROUND: Results on the association between P-wave duration and the risk of atrial fibrillation (AF) are conflicting. OBJECTIVE: The purpose of this study was to obtain a detailed description of the relationship between P-wave duration and the risk of AF. METHODS: Using computerized analysis of electrocardiograms from a large primary care population, we evaluated the association between P-wave duration and the risk of AF. Secondary end-points were death from cardiovascular causes and putative ischemic stroke. Data on drug use, comorbidity, and outcomes were collected from administrative registries. RESULTS: A total of 285,933 individuals were included. During median follow-up period of 6.7 years, 9550 developed AF, 9371 died of a cardiovascular cause, and 8980 had a stroke. Compared with the reference group (100-105 ms), individuals with very short (≤89 ms; hazard ratio [HR] 1.60, 95% confidence interval [CI] 1.41-1.81), intermediate (112-119 ms; HR 1.22, 95% CI 1.13-1.31), long (120-129 ms; HR 1.50, 95% CI 1.39-1.62), and very long P-wave duration (≥130 ms; HR 2.06, 95% CI 1.89-2.23) had an increased risk of incident AF. With respect to death from cardiovascular causes, we found an increased risk for very short (≤89 ms; HR 1.20, 95% CI 1.06-1.34), long (120-129 ms; HR 1.11, 95% CI 1.04-1.19), and very long P-wave duration (≥130 ms; HR 1.30, 95% CI 1.21-1.40) compared with the reference group (106-111 ms). Similar but weaker associations were found between P-wave duration and the risk of putative ischemic stroke. CONCLUSION: In a large primary care population we found both short and long P-wave duration to be robustly associated with an increased risk of AF.
BACKGROUND: Results on the association between P-wave duration and the risk of atrial fibrillation (AF) are conflicting. OBJECTIVE: The purpose of this study was to obtain a detailed description of the relationship between P-wave duration and the risk of AF. METHODS: Using computerized analysis of electrocardiograms from a large primary care population, we evaluated the association between P-wave duration and the risk of AF. Secondary end-points were death from cardiovascular causes and putative ischemic stroke. Data on drug use, comorbidity, and outcomes were collected from administrative registries. RESULTS: A total of 285,933 individuals were included. During median follow-up period of 6.7 years, 9550 developed AF, 9371 died of a cardiovascular cause, and 8980 had a stroke. Compared with the reference group (100-105 ms), individuals with very short (≤89 ms; hazard ratio [HR] 1.60, 95% confidence interval [CI] 1.41-1.81), intermediate (112-119 ms; HR 1.22, 95% CI 1.13-1.31), long (120-129 ms; HR 1.50, 95% CI 1.39-1.62), and very long P-wave duration (≥130 ms; HR 2.06, 95% CI 1.89-2.23) had an increased risk of incident AF. With respect to death from cardiovascular causes, we found an increased risk for very short (≤89 ms; HR 1.20, 95% CI 1.06-1.34), long (120-129 ms; HR 1.11, 95% CI 1.04-1.19), and very long P-wave duration (≥130 ms; HR 1.30, 95% CI 1.21-1.40) compared with the reference group (106-111 ms). Similar but weaker associations were found between P-wave duration and the risk of putative ischemic stroke. CONCLUSION: In a large primary care population we found both short and long P-wave duration to be robustly associated with an increased risk of AF.
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