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Orthogonal P-wave morphology, conventional P-wave indices, and the risk of atrial fibrillation in the general population using data from the Finnish Hospital Discharge Register

Eranti, Antti ; Carlson, Jonas LU orcid ; Kenttä, Tuomas ; Holmqvist, Fredrik LU ; Holkeri, Arttu ; Haukilahti, M. Anette ; Kerola, Tuomas ; Aro, Aapo L. ; Rissanen, Harri and Noponen, Kai , et al. (2020) In Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 22(8). p.1173-1181
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... (More)

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.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Electrocardiography, Interatrial block, P wave, P-terminal force, Atrial fibrillation
in
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
volume
22
issue
8
pages
9 pages
publisher
Oxford University Press
external identifiers
  • pmid:32556298
  • scopus:85089129231
ISSN
1532-2092
DOI
10.1093/europace/euaa118
language
English
LU publication?
yes
id
9fca825f-7976-45f1-9798-83be9faca94b
date added to LUP
2020-08-18 10:34:34
date last changed
2024-06-12 18:50:31
@article{9fca825f-7976-45f1-9798-83be9faca94b,
  abstract     = {{<p>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 &lt; 0.001) were independently associated with the risk of hospitalization with AF. Subjects with P-wave &lt;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.</p>}},
  author       = {{Eranti, Antti and Carlson, Jonas and Kenttä, Tuomas and Holmqvist, Fredrik and Holkeri, Arttu and Haukilahti, M. Anette and Kerola, Tuomas and Aro, Aapo L. and Rissanen, Harri and Noponen, Kai and Seppänen, Tapio and Knekt, Paul and Heliövaara, Markku and Huikuri, Heikki V. and Junttila, M. Juhani and Platonov, Pyotr G.}},
  issn         = {{1532-2092}},
  keywords     = {{Electrocardiography; Interatrial block; P wave; P-terminal force; Atrial fibrillation}},
  language     = {{eng}},
  number       = {{8}},
  pages        = {{1173--1181}},
  publisher    = {{Oxford University Press}},
  series       = {{Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology}},
  title        = {{Orthogonal P-wave morphology, conventional P-wave indices, and the risk of atrial fibrillation in the general population using data from the Finnish Hospital Discharge Register}},
  url          = {{http://dx.doi.org/10.1093/europace/euaa118}},
  doi          = {{10.1093/europace/euaa118}},
  volume       = {{22}},
  year         = {{2020}},
}