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P-wave duration and the risk of atrial fibrillation: Results from the Copenhagen ECG Study
Jonas B Nielsen1, Jørgen T Kühl2, Adrian Pietersen3
1Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark; Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Insights
Both short and long P-wave duration increase the risk of atrial fibrillation (AF). This large study clarifies the association between P-wave duration and AF incidence, cardiovascular death, and stroke.
Area of Science:
- Cardiology
- Electrocardiography
- Epidemiology
Background:
- Conflicting results exist regarding the association between P-wave duration and atrial fibrillation (AF) risk.
- Understanding this relationship is crucial for risk stratification and prevention strategies.
Purpose of the Study:
- To comprehensively investigate the association between P-wave duration and the risk of developing AF.
- To explore secondary associations with cardiovascular death and ischemic stroke.
Main Methods:
- Computerized electrocardiogram analysis of a large primary care population.
- Evaluation of P-wave duration against AF incidence, cardiovascular mortality, and stroke.
- Utilized administrative registries for comprehensive outcome and comorbidity data collection.
Main Results:
- A significant association was observed between P-wave duration and AF risk across various durations, with both very short (≤89 ms) and very long (≥130 ms) durations showing the highest hazard ratios.
- Increased risk for cardiovascular death was noted for very short, long, and very long P-wave durations.
- Weaker associations were found between P-wave duration and the risk of putative ischemic stroke.
Conclusions:
- Both abnormally short and long P-wave durations are robustly associated with an increased risk of incident atrial fibrillation.
- These findings highlight P-wave duration as a significant electrocardiographic marker for cardiovascular risk.
Background:
Results on the association between P-wave duration and the risk of atrial fibrillation (AF) are conflicting.
Objective:
The purpose of this study was to obtain a detailed description of the relationship between P-wave duration and the risk of AF.
Methods:
Using computerized analysis of electrocardiograms from a large primary care population, we evaluated the association between P-wave duration and the risk of AF. Secondary end-points were death from cardiovascular causes and putative ischemic stroke. Data on drug use, comorbidity, and outcomes were collected from administrative registries.
Results:
A total of 285,933 individuals were included. During median follow-up period of 6.7 years, 9550 developed AF, 9371 died of a cardiovascular cause, and 8980 had a stroke. Compared with the reference group (100-105 ms), individuals with very short (≤89 ms; hazard ratio [HR] 1.60, 95% confidence interval [CI] 1.41-1.81), intermediate (112-119 ms; HR 1.22, 95% CI 1.13-1.31), long (120-129 ms; HR 1.50, 95% CI 1.39-1.62), and very long P-wave duration (≥130 ms; HR 2.06, 95% CI 1.89-2.23) had an increased risk of incident AF. With respect to death from cardiovascular causes, we found an increased risk for very short (≤89 ms; HR 1.20, 95% CI 1.06-1.34), long (120-129 ms; HR 1.11, 95% CI 1.04-1.19), and very long P-wave duration (≥130 ms; HR 1.30, 95% CI 1.21-1.40) compared with the reference group (106-111 ms). Similar but weaker associations were found between P-wave duration and the risk of putative ischemic stroke.
Conclusion:
In a large primary care population we found both short and long P-wave duration to be robustly associated with an increased risk of AF.
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