Long-Term Prognostic Value of P-Wave Characteristics for the Development of Atrial Fibrillation in Subjects Aged 55 to 74 Years at Baseline (original) (raw)
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The American Journal of Cardiology, 2011
Long-term risk prediction is a priority for the prevention of atrial fibrillation (AF). P wave indices are electrocardiographic measurements describing atrial conduction. The role of P wave indices in the prospective determination of AF and mortality risk has had limited assessment. We quantified by digital caliper the P wave indices of maximum duration and dispersion in 1,550 Framingham Heart Study participants >60 years old (58% women) from single-channel electrocardiograms recorded from 1968 through 1971. We examined the association of selected P wave indices and long-term outcomes using Cox proportional hazards regression incorporating age, gender, body mass index, systolic blood pressure, treatment for hypertension, significant murmur, heart failure, and PR interval. Over a median follow-up of 15.8 years (range 0 to 38.7), 359 participants developed AF and 1,525 died. Multivariable-adjusted hazard ratios (HRs) per SD increase in maximum P wave duration were 1.15 (95% confidence interval [CI] 0.90 to 1.47, p ؍ 0.27) for AF and 1.02 (95% CI 0.96 to 1.08, p ؍ 0.18) for mortality. The upper 5% of P wave maximum duration had a multivariable-adjusted HR of 2.51 (95% CI 1.13 to 5.57, p ؍ 0.024) for AF and an HR of 1.11 (95% CI 0.87 to 1.40, p ؍ 0.20) for mortality. We found no significant associations between P wave dispersion with incidence of AF or mortality. In conclusion, maximum P wave duration at the upper fifth percentile was associated with long-term AF risk in an elderly community-based cohort. P wave duration is an electrocardiographic endophenotype for AF.
P Wave Signal-Averaged Electrocardiography to Identify Risk for Atrial Fibrillation
Pacing and Clinical Electrophysiology, 2002
Averaged Electrocardiography to Identify Risk for Atrial Fibrillation. AF is the most common sustained cardiac arrhythmia, and this prevalence is increasing. The impact of AF on morbidity and mortality is substantial, as are the socioeconomic consequences like higher health care costs, chronic disease management, and disabilities. Early recognition of patients at high risk for AF, combined with effective management, may help prevent AF from becoming chronic, helping to minimize potential health risks, costs, and other complications. P wave signal-averaged electrocardiography (SAECG) has been shown to have a potential role in identifying patients at risk of developing paroxysmal AF and those likely to change from paroxysmal AF to chronic AF. The theoretical rationale of P wave SAECG in patients with AF is delay in the intraatrial and interatrial conduction. Intraatrial conduction delays can be seen on the surface electrocardiogram as P wave prolongation, which is more visible with averaging techniques and high resolution recording devices. Averaging followed by amplification after proper filtering of the electrical signal allows more precise measurements of duration and amplitude of the P wave. Data on reproducibility, filter settings, number of beats to be averaged, and definitions of the onset and offset depend on the system used, which can be QRS or, preferably, P wave triggered. A prolonged P wave duration is one of the best predictors of perioperative AF, but the role of P wave SAECG in the paroxysmal form is less well defined. Combining P wave duration with other predictors for AF improves the diagnostic value of P wave SAECG.
Relationship between P-wave duration and the risk of atrial fibrillation
Expert review of cardiovascular therapy, 2018
P-wave duration (PWD) is an electrocardiographic (ECG) marker reflecting atrial conduction, and studies have shown that its prolongation is associated with atrial fibrillation. Areas covered: This review addresses the relationship between PWD and atrial fibrillation, how anatomic and physiologic changes in the atria potentiate the risk for atrial fibrillation, and how these atrial anatomic and physiologic changes relate to PWD. Other P-wave related entities, such as P-wave terminal force in V1, PR interval, and P wave axis are also addressed. Expert commentary: Atrial fibrillation is a manifestation of the underlying atrial disease. Fibrotic collagen deposition interrupts the electrical flow and thus can potentiate the transition from sinus rhythm to atrial fibrillation. PWD is an ECG parameter that provides insight into the intricacies of the atria and could be a useful marker for assessing the risk for atrial fibrillation. The main obstacle for broad utilization of PWD is that it ...
P-wave Indices to Detect Susceptibility to Atrial Fibrillation
The aim of this work is to present different markers resulting from the analysis of a single ECG lead recorded during sinus rhythm. To this purpose, the ECGs from three populations were compared: healthy subjects, patients subject to paroxysmal AF selected for catheter ablation, under general anesthesia or not. In addition to standard temporal P-wave parameters (P-wave duration and PQ interval), an index of P-wave stability over time defined as the Euclidean distance between beat-to-beat P waves, and morphologic characteristics of biphasic P-wave, such as P-wave initial force and terminal force, were studied. Significant differences between the healthy and pathological groups were obtained for the considered parameters. Moreover, a classification of the two groups based on the joint analysis of P-wave duration and PQ interval was suggested. In parallel, the analysis revealed that there are no significant differences in parameters between the groups under anesthesia or not. In conclusion, this study provides valuable markers for the early recognition of patients at high risk for atrial fibrillation which may guide upstream therapy.
P Wave Signal-Averaged ECG in Normal Population and in Patients with Converted Atrial Fibrillation
Annals of Noninvasive Electrocardiology, 2011
Background: Signal-averaged electrocardiography of the P wave (P wave SAECG) is a noninvasive method for evaluating the risk of atrial fibrillation (AF). We aimed to study P wave SAECG parameters in a large number of apparently healthy subjects and to compare them with patients with converted AF. Methods: We examined 591 individuals; P wave SAECG were recorded in 330 normal subjects, 31 patients with converted persistent AF and 57 patients with converted paroxysmal AF immediately after conversion, at 12 and 24 hours after conversion, then after 3 and 6 months. P wave SAECG were recorded using a commercially available machine aiming to obtain a noise level <1 μV. Results: In the normal population the duration of the filtered P wave (PWD) was higher in men. P wave duration, RMS 40 and RMS 30 were significantly correlated with age. By comparing the normal population with patients with persistent AF converted to sinus rhythm we demonstrated significant differences in PWD and P wave integral. Patients with recurrent persistent AF had significantly higher PWD. The study of patients with paroxysmal AF, compared to the control group, showed significant increase of the same parameters: PWD and integral of the P wave. Patients with recurrent paroxysmal AF had higher PWD and lower RMS 40 , RMS 30 , RMS 20. Conclusions: Filtered P wave duration was higher in men; PWD was weakly but significantly correlated with age. Patients with paroxysmal or persistent AF converted to sinus rhythm had significantly higher P wave duration and P wave integral.
International journal of cardiology, 2004
Atrial fibrillation (AF) is the most common arrhythmia observed in hypertropic cardiomyopathy (HCM) and is associated with an acute deterioration. Recently, P wave dispersion (PWD) reflecting inhomogenous atrial conduction has been proposed as being useful for the estimation of paroxysmal AF. In this study, we aimed to define the clinical, echocardiographic and electrocardiographic predictors for AF occurence in patients with HCM. Twenty-seven patients diagnosed with HCM and having a history of documented AF attack were compared with 53 age-and gender-matched patients who had no such history. LA diameter was significantly greater and gradient in the left ventricle outflow tract was lower in patients with AF than those without AF. Maximum P-wave duration (Pmax), PWD and PTF1 values were significantly higher in patients with AF. A Pmax > 134.5 ms separated the patients with AF from controls with a sensitivity of 92%, specificity of 89% and a positive predictive value of 80%. A PWD value >52.5 ms separated patients from controls with a sensitivity of 96%, a specificity of 91% and a positive predictive accuracy of 84%. An LA diameter >4.2 cm separated patients from controls with a sensitivity of 96% and a specificity of 81%. We concluded that LA diameter and PWD values are the most significant predictors for AF occurence in patients with HCM, and simply by measuring Pmax and PWD values, we could easily identify the patients with high risk, and prescribe the necessary treatment and follow-up protocols for such patients.
Pacing and Clinical Electrophysiology, 2003
The authors hypothesized that the persistence of abnormal atrial conduction detected by serial P wave signal-averaged electrocardiograms (P-SAECGs) can identify patients who are at high risk of recurrent atrial fibrillation (R-AF) following electrical cardioversion (ECV). P-SAECGs were recorded in 60 consecutive patients after ECV (53 men, age 66 ± 10 years) and repeated in those who had remained in sinus rhythm (SR) 1 week, and 1, 3, and 6 months later. Filtered P wave duration (PD), root mean square (RMS) voltage of the terminal 40, 30, 20 ms of the filtered P wave, RMS voltage of the entire filtered P wave (RMS-p), and the integral of the voltages in the entire P wave (integral-p) were analyzed. Thirty-one (52%) patients returned to AF within 1 week, an additional 11 (18%) by 1 month, and a further 2 (3.3%) at each subsequent assessment (3 and 6 months). The patients with R-AF had longer PD (157 ± 24 vs 143 ± 17 ms, P < 0.0001) and lower ± 2.0 vs 6.1 ± 3.4 µV, P = 0.007; 4.3 ± 1.5 vs 5.7 ± 3.2 µV, P < 0.0001; 3.6 ± 1.4 vs 5.2 ± 3.0 µV, P < 0.0001, respectively) than those who remained in SR. These measurements did not change significantly in either group. RMS-p increased in SR patients (P = 0.009) but decreased in those who subsequently reverted to AF (P = 0.032) with a significant difference between the slopes of the RMS-p change (P = 0.006). Integral-p decreased from the time of ECV in the R-AF group only (P = 0.0028) and created a significant difference between the two slopes (P = 0.0004). The evolution of P-SAECG parameters after ECV differs in patients whose AF recurs versus patients who remain in SR. (PACE 2003; 26[Pt. II]:299-304) atrial fibrillation, P wave, signal-averaged electrocardiogram, cardioversion
Europace, 2007
Aims Atrial fibrillation (AF) is a common arrhythmia in advanced heart failure. The occurrence of AF increases the risk of death and hospitalization for patients with heart failure. The results of different studies indicated that patients with paroxysmal AF have a longer filtered P wave duration (FPD), a lower root mean square voltage of the last 20 ms of the P wave (RMS 20), and a lower chemoreflexsensitivity (CHRS). Our study bases on these observations in order to examine the methods for predicting AF in patients with a left ventricular ejection fraction below 40% without a prior documentation of AF. Methods and results The ratio between the difference of RR intervals in ECG and venous pO 2 before and after 5-min oxygen inhalation was measured (ms/mmHg) in order to determine the CHRS. A P wave signal-averaged ECG was performed for the measurement of FPD and RMS 20. The measurements were only performed in 94 patients with sinus rhythm. AF occurred during the mean follow-up of 39.9 months in 24 patients (26%). There were no significant differences concerning age, heart diseases, sex, ejection fraction, heart rate, or the use of drugs. The FPD (130.3 + 4.2 vs. 118.9 + 12.4 ms, P , 0.0001) was significantly longer and the RMS 20 (3.03 + 0.95 vs. 3.83 + 1.58 mV, P ¼ 0.02) was significantly lower in patients with AF than in sinus rhythm. The CHRS did not differ significantly between both groups (3.57 + 1.49 vs. 3.48 + 1.62 ms/mmHg, P ¼ 0.81). The x 2 test showed that the threshold of FPD 125 ms and RMS 20 3.3 mV revealed the best predictive value for AF. A stepwise logistic regression analysis of all variables identified the threshold of FPD 125 ms and RMS 20 3.3 mV (OR 18.71; 95% CI, 4.85-72.16, P , 0.0001) as independent predictors for AF. Conclusions In summary, our data show that the results of a P wave signal-averaged ECG can predict the risk for new onset of AF in patients with heart failure. The value of signal-averaged FPD is probably the result of reflecting the intra-atrial conduction delay, which is a pathophysiological condition for AF. The CHRS is not a suitable method for predicting AF.
Electrocardiographic predictors of atrial fibrillation
American Heart Journal, 2009
Background Atrial fibrillation (AF) is the most prevalent arrhythmia in the United States and accounts for more than 750,000 strokes per year. Noninvasive predictors of AF may help identify patients at risk of developing AF. Our objective was to identify the electrocardiographic characteristics associated with onset of AF.