Abnormal P-Wave Morphology Is a Predictor of Atrial Fibrillation Development and Cardiac Death in MADIT II Patients
(2010) In Annals of Noninvasive Electrocardiology 15(1). p.63-72- Abstract
- Background: Several ECG-based approaches have been shown to add value when risk-stratifying patients with congestive heart failure, but little attention has been paid to the prognostic value of abnormal atrial depolarization in this context. The aim of this study was to noninvasively analyze the atrial depolarization phase to identify markers associated with increased risk of mortality, deterioration of heart failure, and development of atrial fibrillation (AF) in a high-risk population with advanced congestive heart failure and a history of acute myocardial infarction. Methods: Patients included in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) with sinus rhythm at baseline were studied (n = 802). Unfiltered and... (More)
- Background: Several ECG-based approaches have been shown to add value when risk-stratifying patients with congestive heart failure, but little attention has been paid to the prognostic value of abnormal atrial depolarization in this context. The aim of this study was to noninvasively analyze the atrial depolarization phase to identify markers associated with increased risk of mortality, deterioration of heart failure, and development of atrial fibrillation (AF) in a high-risk population with advanced congestive heart failure and a history of acute myocardial infarction. Methods: Patients included in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) with sinus rhythm at baseline were studied (n = 802). Unfiltered and band-pass filtered signal-averaged P waves were analyzed to determine orthogonal P-wave morphology (prespecified types 1, 2, and 3/atypical), P-wave duration, and RMS20. The association between P-wave parameters and data on the clinical course and cardiac events during a mean follow-up of 20 months was analyzed. Results: P-wave duration was 139 +/- 23 ms and the RMS20 was 1.9 +/- 1.1 mu V. None of these parameters was significantly associated with poor cardiac outcome or AF development. After adjustment for clinical covariates, abnormal P-wave morphology was found to be independently predictive of nonsudden cardiac death (HR 2.66; 95% CI 1.41-5.04, P = 0.0027) and AF development (HR 1.75; 95% CI 1.10-2.79, P = 0.019). Conclusion: Abnormalities in P-wave morphology recorded from orthogonal leads in surface ECG are independently predictive of increased risk of nonsudden cardiac death and AF development in MADIT II patients. Ann Noninvasive Electrocardiol 2010;15(1):63-72 (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/1547378
- author
- Holmqvist, Fredrik LU ; Platonov, Pyotr LU ; McNitt, Scott ; Polonsky, Slava ; Carlson, Jonas LU ; Zareba, Wojciech and Moss, Arthur J.
- organization
- publishing date
- 2010
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- ICD, atrial electrophysiology, ischemic heart disease, atrial, fibrillation, ECG
- in
- Annals of Noninvasive Electrocardiology
- volume
- 15
- issue
- 1
- pages
- 63 - 72
- publisher
- Wiley-Blackwell
- external identifiers
-
- wos:000273821100010
- pmid:20146784
- scopus:75649152796
- pmid:20146784
- ISSN
- 1082-720X
- DOI
- 10.1111/j.1542-474X.2009.00341.x
- language
- English
- LU publication?
- yes
- id
- 4dd205c4-4e81-46f5-889b-5be923ad3583 (old id 1547378)
- alternative location
- http://www.ncbi.nlm.nih.gov/pubmed/20146784?dopt=Abstract
- date added to LUP
- 2016-04-01 09:57:23
- date last changed
- 2022-04-04 00:59:46
@article{4dd205c4-4e81-46f5-889b-5be923ad3583, abstract = {{Background: Several ECG-based approaches have been shown to add value when risk-stratifying patients with congestive heart failure, but little attention has been paid to the prognostic value of abnormal atrial depolarization in this context. The aim of this study was to noninvasively analyze the atrial depolarization phase to identify markers associated with increased risk of mortality, deterioration of heart failure, and development of atrial fibrillation (AF) in a high-risk population with advanced congestive heart failure and a history of acute myocardial infarction. Methods: Patients included in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) with sinus rhythm at baseline were studied (n = 802). Unfiltered and band-pass filtered signal-averaged P waves were analyzed to determine orthogonal P-wave morphology (prespecified types 1, 2, and 3/atypical), P-wave duration, and RMS20. The association between P-wave parameters and data on the clinical course and cardiac events during a mean follow-up of 20 months was analyzed. Results: P-wave duration was 139 +/- 23 ms and the RMS20 was 1.9 +/- 1.1 mu V. None of these parameters was significantly associated with poor cardiac outcome or AF development. After adjustment for clinical covariates, abnormal P-wave morphology was found to be independently predictive of nonsudden cardiac death (HR 2.66; 95% CI 1.41-5.04, P = 0.0027) and AF development (HR 1.75; 95% CI 1.10-2.79, P = 0.019). Conclusion: Abnormalities in P-wave morphology recorded from orthogonal leads in surface ECG are independently predictive of increased risk of nonsudden cardiac death and AF development in MADIT II patients. Ann Noninvasive Electrocardiol 2010;15(1):63-72}}, author = {{Holmqvist, Fredrik and Platonov, Pyotr and McNitt, Scott and Polonsky, Slava and Carlson, Jonas and Zareba, Wojciech and Moss, Arthur J.}}, issn = {{1082-720X}}, keywords = {{ICD; atrial electrophysiology; ischemic heart disease; atrial; fibrillation; ECG}}, language = {{eng}}, number = {{1}}, pages = {{63--72}}, publisher = {{Wiley-Blackwell}}, series = {{Annals of Noninvasive Electrocardiology}}, title = {{Abnormal P-Wave Morphology Is a Predictor of Atrial Fibrillation Development and Cardiac Death in MADIT II Patients}}, url = {{http://dx.doi.org/10.1111/j.1542-474X.2009.00341.x}}, doi = {{10.1111/j.1542-474X.2009.00341.x}}, volume = {{15}}, year = {{2010}}, }