Abstract
BackgroundP‐wave duration (PDURATION) and P‐wave area (PAREA) have been linked to risk of atrial fibrillation (AF), but they do not improve the efficacy of Framingham AF risk score. We suggest the incorporation of both variables in one index, the P‐wave area/P‐wave duration (PAREA / DURATION) index, which may be considered an expression of the average amplitude of the P wave that reflects aspects of P‐wave morphology.ObjectiveTo assess the prognostic value of P‐wave area/P‐wave duration index (PAREA/DURATION index) in lead II together with other P‐wave indices (PWIs) in incidence of AF in the Copenhagen Holter Study.MethodsThe study included 632 men and women, between 55 and 75 years with no apparent heart disease or AF. Baseline standard 12‐lead Electrocardiography (ECGs) were analyzed manually.ResultsThe median follow‐up time was 14.7 (14.5;14.9) years. A total of 68 cases of AF and 233 cases of death were recorded. The restricted cubic spline method showed a U‐shaped association between PAREA/DURATION and rate of AF. The lowest quintile of PAREA/DURATION index in lead II was associated with increased rate of AF, HR 2.80 (1.64–4.79). The addition of the new index to the Framingham model for AF improved the model in this population. The PAREA in lead II in its lowest quintile was also associated with increased rate of AF, HR 2.16 (1.25–3.75), but did not improve the Framingham model. PDURATION and P‐wave terminal force (PTF) were not significantly associated with AF.ConclusionA flat P wave as expressed by a small PAREA/DURATION index in lead II is associated with increased rate of incident AF beyond known AF risk factors.
Highlights
Atrial fibrillation (AF) is the most common arrhythmia of clinical significance (Kirchhof et al, 2016)
Previous studies have stipulated that P-wave indices (PWI) may be useful in determining which patients are at risk of developing AF (Aizawa, 2017; German, Kabir, Dewland, Henrikson, & Tereshchenko, 2016; Magnani et al, 2015)
This was an exploratory study that aimed to assess the prognostic value of the P-wave area (PAREA)/DURATION index and other PWI in incidence of AF The major finding of this study is that a flat P wave (Figure 1) expressed as a small PAREA/DURATION index in lead II, is significantly associated with long-term incidence of AF after relevant adjustments
Summary
Atrial fibrillation (AF) is the most common arrhythmia of clinical significance (Kirchhof et al, 2016). Previous studies have stipulated that P-wave indices (PWI) may be useful in determining which patients are at risk of developing AF (Aizawa, 2017; German, Kabir, Dewland, Henrikson, & Tereshchenko, 2016; Magnani et al, 2015) Such measures include P-wave duration (PDURATION), P-wave area (PAREA), and P-wave terminal force (PTF). This index can be considered a calculated expression of the average p-wave amplitude, since it is the ratio between the area and the duration of the P wave Integrating both PAREA and PDURATION in one single index that may reflect different electrophysiological abnormalities may provide a better measure of left atrial abnormalities and a better marker of AF. The study aimed to investigate the effect of adding PWI to the Framingham AF risk score (Schnabel et al, 2009)
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