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Usefulness of the Electrocardiographic P-Wave Axis as a Predictor of Atrial Fibrillation
Maria Octavia Rangel1, Wesley T O'Neal2, Elsayed Z Soliman3
1Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Insights
An abnormal P-wave axis on an electrocardiogram is linked to a higher risk of developing atrial fibrillation (AF). This common ECG finding may help assess AF risk in the general population.
Area of Science:
- Cardiology
- Electrophysiology
- Epidemiology
Background:
- The relationship between an abnormal P-wave axis and atrial fibrillation (AF) is not well-established in community settings.
- Electrocardiography (ECG) is a routine diagnostic tool in cardiovascular health.
Purpose of the Study:
- To investigate the association between an abnormal P-wave axis and the incidence of AF in a large, community-based cohort.
- To determine if P-wave axis can serve as a predictor for AF risk.
Main Methods:
- Analysis of 4,274 participants from the Cardiovascular Health Study.
- Identification of AF cases through ECGs and hospitalization data over a median follow-up of 12.1 years.
- Statistical adjustment for numerous cardiovascular risk factors and demographic variables.
Main Results:
- A total of 1,274 participants developed AF during follow-up.
- Abnormal P-wave axis was associated with a 17% increased risk of AF (95% CI: 1.03–1.33) after multivariable adjustment.
- Findings remained consistent across age, gender, and race subgroups.
Conclusions:
- An abnormal P-wave axis, a standard ECG finding, is significantly associated with an increased risk of developing atrial fibrillation.
- P-wave axis may represent a valuable, routinely available biomarker for AF risk stratification in clinical practice.
Abstract:
The association between abnormal electrocardiographic P-wave axis with atrial fibrillation (AF) has not been systematically studied in community-based populations. We examined the association between abnormal P-wave axis and AF in 4,274 participants (41% men and 95% white) from the Cardiovascular Health Study. Axis values between 0° and 75° were considered normal. AF cases were identified from study electrocardiograms and from hospitalization discharge data. During a median follow-up of 12.1 years, a total of 1,274 participants (30%) developed AF. The incidence rate of AF was 26 cases per 1,000 person-years for those with abnormal P-wave axis and 24 cases per 1,000 person-years for subjects with normal P-wave axis. Abnormal P-wave axis was associated with a 17% increased risk of AF (95% confidence interval 1.03 to 1.33) after adjustment for age, gender, race, education, income, smoking, diabetes, coronary heart disease, stroke, heart failure, heart rate, systolic blood pressure, body mass index, total cholesterol, high-density lipoprotein cholesterol, antihypertensive medications, aspirin, and statins. The results were consistent in subgroup analyses stratified by age, gender, and race. In conclusion, abnormal P-wave axis, a routinely reported electrocardiographic measurement, is associated with an increased risk of AF. This finding suggests a potential role for P-wave axis in AF risk assessment.
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