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Risk prediction of atrial fibrillation based on electrocardiographic interatrial block

Skov, Morten W.; Ghouse, Jonas; Kühl, Jørgen T.; Platonov, Pyotr G. LU ; Graff, Claus; Fuchs, Andreas; Rasmussen, Peter V.; Pietersen, Adrian; Nordestgaard, Børge G. and Torp-Pedersen, Christian, et al. (2018) In Journal of the American Heart Association 7(11).
Abstract

Background--The electrocardiographic interatrial block (IAB) has been associated with atrial fibrillation (AF). We aimed to test whether IAB can improve risk prediction of AF for the individual person. Methods and Results--Digital ECGs of 152 759 primary care patients aged 50 to 90 years were collected from 2001 to 2011. We identified individuals with P-wave ≥120 ms and the presence of none, 1, 2, or 3 biphasic P-waves in inferior leads. Data on comorbidity, medication, and outcomes were obtained from nationwide registries. We observed a dose-response relationship between the number of biphasic P-waves in inferior leads and the hazard of AF during follow-up. Discrimination of the 10-year outcome of AF, measured by time-dependent area... (More)

Background--The electrocardiographic interatrial block (IAB) has been associated with atrial fibrillation (AF). We aimed to test whether IAB can improve risk prediction of AF for the individual person. Methods and Results--Digital ECGs of 152 759 primary care patients aged 50 to 90 years were collected from 2001 to 2011. We identified individuals with P-wave ≥120 ms and the presence of none, 1, 2, or 3 biphasic P-waves in inferior leads. Data on comorbidity, medication, and outcomes were obtained from nationwide registries. We observed a dose-response relationship between the number of biphasic P-waves in inferior leads and the hazard of AF during follow-up. Discrimination of the 10-year outcome of AF, measured by time-dependent area under the curve, was increased by 1.09% (95% confidence interval 0.43-1.74%) for individuals with cardiovascular disease at baseline (CVD) and 1.01% (95% confidence interval 0.40-1.62%) for individuals without CVD, when IAB was added to a conventional risk model for AF. The highest effect of IAB on the absolute risk of AF was observed in individuals aged 60 to 70 years with CVD. In this subgroup, the 10-year risk of AF was 50% in those with advanced IAB compared with 10% in those with a normal P-wave. In general, individuals with advanced IAB and no CVD had a higher risk of AF than patients with CVD and no IAB. Conclusions--IAB improves risk prediction of AF when added to a conventional risk model. Clinicians may consider monitoring patients with IAB more closely for the occurrence of AF, especially for high-risk subgroups.

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published
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keywords
Atrial fibrillation, ECG, Epidemiology, Interatrial, Interatrial block, Ischemic stroke, Risk prediction
in
Journal of the American Heart Association
volume
7
issue
11
publisher
Wiley-Blackwell
external identifiers
  • scopus:85047999051
ISSN
2047-9980
DOI
10.1161/JAHA.117.008247
language
English
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yes
id
e13be6e2-e4b0-439b-a0c5-4693bd4e48c2
date added to LUP
2018-06-12 13:25:46
date last changed
2018-10-03 11:52:29
@article{e13be6e2-e4b0-439b-a0c5-4693bd4e48c2,
  abstract     = {<p>Background--The electrocardiographic interatrial block (IAB) has been associated with atrial fibrillation (AF). We aimed to test whether IAB can improve risk prediction of AF for the individual person. Methods and Results--Digital ECGs of 152 759 primary care patients aged 50 to 90 years were collected from 2001 to 2011. We identified individuals with P-wave ≥120 ms and the presence of none, 1, 2, or 3 biphasic P-waves in inferior leads. Data on comorbidity, medication, and outcomes were obtained from nationwide registries. We observed a dose-response relationship between the number of biphasic P-waves in inferior leads and the hazard of AF during follow-up. Discrimination of the 10-year outcome of AF, measured by time-dependent area under the curve, was increased by 1.09% (95% confidence interval 0.43-1.74%) for individuals with cardiovascular disease at baseline (CVD) and 1.01% (95% confidence interval 0.40-1.62%) for individuals without CVD, when IAB was added to a conventional risk model for AF. The highest effect of IAB on the absolute risk of AF was observed in individuals aged 60 to 70 years with CVD. In this subgroup, the 10-year risk of AF was 50% in those with advanced IAB compared with 10% in those with a normal P-wave. In general, individuals with advanced IAB and no CVD had a higher risk of AF than patients with CVD and no IAB. Conclusions--IAB improves risk prediction of AF when added to a conventional risk model. Clinicians may consider monitoring patients with IAB more closely for the occurrence of AF, especially for high-risk subgroups.</p>},
  articleno    = {e008247},
  author       = {Skov, Morten W. and Ghouse, Jonas and Kühl, Jørgen T. and Platonov, Pyotr G. and Graff, Claus and Fuchs, Andreas and Rasmussen, Peter V. and Pietersen, Adrian and Nordestgaard, Børge G. and Torp-Pedersen, Christian and Hansen, Steen M. and Olesen, Morten S. and Haunsø, Stig and Køber, Lars and Gerds, Thomas A. and Kofoed, Klaus F. and Svendsen, Jesper H. and Holst, Anders G. and Nielsen, Jonas B.},
  issn         = {2047-9980},
  keyword      = {Atrial fibrillation,ECG,Epidemiology,Interatrial,Interatrial block,Ischemic stroke,Risk prediction},
  language     = {eng},
  month        = {06},
  number       = {11},
  publisher    = {Wiley-Blackwell},
  series       = {Journal of the American Heart Association},
  title        = {Risk prediction of atrial fibrillation based on electrocardiographic interatrial block},
  url          = {http://dx.doi.org/10.1161/JAHA.117.008247},
  volume       = {7},
  year         = {2018},
}