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Abnormal P-Wave Morphology Is a Predictor of Atrial Fibrillation Development and Cardiac Death in MADIT II Patients

Holmqvist, Fredrik LU ; Platonov, Pyotr LU ; McNitt, Scott; Polonsky, Slava; Carlson, Jonas LU ; Zareba, Wojciech and Moss, Arthur J. (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:
author
organization
publishing date
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
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
2010-02-23 14:58:18
date last changed
2018-05-29 10:41:25
@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},
  keyword      = {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},
  volume       = {15},
  year         = {2010},
}