Antti Eranti1, Jonas Carlson2, Tuomas Kenttä3, Fredrik Holmqvist4, Arttu Holkeri5, M Anette Haukilahti3, Tuomas Kerola6, Aapo L Aro5, Harri Rissanen7, Kai Noponen8, Tapio Seppänen8, Paul Knekt7, Markku Heliövaara7, Heikki V Huikuri3, M Juhani Junttila3, Pyotr G Platonov4. 1. Heart Center, Central Hospital of North Karelia, Tikkamäentie 16, 80210 Joensuu, Finland. 2. Department of Cardiology, Lund University, Entrégatan 7, 22185 Lund, Sweden. 3. Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital and University of Oulu, Kajaanintie 50, 90220 Oulu, Finland. 4. Department of Cardiology, Center for Integrative Electrocardiography, Clinical Sciences at Lund University and Arrhythmia Clinic, Skåne University Hospital, Entrégatan 7, 22185 Lund, Sweden. 5. Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland. 6. Department of Internal Medicine, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850 Lahti, Finland. 7. Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Mannerheimintie 166, 00271 Helsinki, Finland. 8. Center for Machine Vision and Signal Analysis, University of Oulu, Pentti Kaiteran katu 1, 90014 Oulu, Finland.
Abstract
AIMS: Identifying subjects at high and low risk of atrial fibrillation (AF) is of interest. This study aims to assess the risk of AF associated with electrocardiographic (ECG) markers linked to atrial fibrosis: P-wave prolongation, 3rd-degree interatrial block, P-terminal force in lead V1, and orthogonal P-wave morphology. METHODS AND RESULTS: P-wave parameters were assessed in a representative Finnish population sample aged ≥30 years (n = 7217, 46.0% male, mean age 51.4 years). Subjects (n = 5489) with a readable ECG including the orthogonal leads, sinus rhythm, and a predefined orthogonal P-wave morphology type [positive in leads X and Y and either negative (Type 1) or ± biphasic (Type 2) in lead Z; Type 3 defined as positive in lead X and ± biphasic in lead Y], were followed 10 years from the baseline examinations (performed 1978-80). Subjects discharged with AF diagnosis after any-cause hospitalization (n = 124) were defined as having developed AF. Third-degree interatrial block was defined as P-wave ≥120 ms and the presence of ≥2 ± biphasic P waves in the inferior leads. Hazard ratios (HRs) and confidence intervals (CIs) were assessed with Cox models. Third-degree interatrial block (n = 103, HR 3.18, 95% CI 1.66-6.13; P = 0.001) and Type 3 morphology (n = 216, HR 3.01, 95% CI 1.66-5.45; P < 0.001) were independently associated with the risk of hospitalization with AF. Subjects with P-wave <110 ms and Type 1 morphology (n = 2074) were at low risk (HR 0.46, 95% CI 0.26-0.83; P = 0.006), compared to the rest of the subjects. CONCLUSION: P-wave parameters associate with the risk of hospitalization with AF. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Identifying subjects at high and low risk of atrial fibrillation (AF) is of interest. This study aims to assess the risk of AF associated with electrocardiographic (ECG) markers linked to atrial fibrosis: P-wave prolongation, 3rd-degree interatrial block, P-terminal force in lead V1, and orthogonal P-wave morphology. METHODS AND RESULTS: P-wave parameters were assessed in a representative Finnish population sample aged ≥30 years (n = 7217, 46.0% male, mean age 51.4 years). Subjects (n = 5489) with a readable ECG including the orthogonal leads, sinus rhythm, and a predefined orthogonal P-wave morphology type [positive in leads X and Y and either negative (Type 1) or ± biphasic (Type 2) in lead Z; Type 3 defined as positive in lead X and ± biphasic in lead Y], were followed 10 years from the baseline examinations (performed 1978-80). Subjects discharged with AF diagnosis after any-cause hospitalization (n = 124) were defined as having developed AF. Third-degree interatrial block was defined as P-wave ≥120 ms and the presence of ≥2 ± biphasic P waves in the inferior leads. Hazard ratios (HRs) and confidence intervals (CIs) were assessed with Cox models. Third-degree interatrial block (n = 103, HR 3.18, 95% CI 1.66-6.13; P = 0.001) and Type 3 morphology (n = 216, HR 3.01, 95% CI 1.66-5.45; P < 0.001) were independently associated with the risk of hospitalization with AF. Subjects with P-wave <110 ms and Type 1 morphology (n = 2074) were at low risk (HR 0.46, 95% CI 0.26-0.83; P = 0.006), compared to the rest of the subjects. CONCLUSION: P-wave parameters associate with the risk of hospitalization with AF. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Lin Yee Chen; Antonio Luiz Pinho Ribeiro; Pyotr G Platonov; Iwona Cygankiewicz; Elsayed Z Soliman; Bulent Gorenek; Takanori Ikeda; Vassilios P Vassilikos; Jonathan S Steinberg; Niraj Varma; Antoni Bayés-de-Luna; Adrian Baranchuk Journal: Circ Arrhythm Electrophysiol Date: 2022-03-25
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