Electrocardiogram (ECG) for the Prediction of Incident Atrial Fibrillation: An Overview

Electrocardiograms (ECGs) have been employed to medically evaluate participants in population-based studies, and ECG-derived predictors have been reported for incident atrial fibrillation (AF). Here, we reviewed the status of ECG in predicting new-onset AF. We surveyed population-based studies and revealed ECG variables to be risk factors for incident AF. When available, the predictive values of each ECG risk marker were calculated. Both the atrium-related and ventricle-related ECG variables were risk factors for incident AF, with significant hazard risks (HRs) even after multivariate adjustments. The risk factors included P-wave indices (maximum P-wave duration, its dispersion or variation and P-wave morphology) and premature atrial contractions (PACs) or runs. In addition, left ventricular hypertrophy (LVH), ST-T abnormalities, intraventricular conduction delay, QTc interval and premature ventricular contractions (PVCs) or runs were a risk of incident AF. An HR of greater than 2.0 was observed in the upper 5th percentile of the P-wave durations, P-wave durations greater than 130 ms, P-wave morpholyg, PACs (PVCs) or runs, LVH, QTc and left anterior fascicular blocks. The sensitivity , specificity and the positive and negative predictive values were 3.6-53.8%, 61.7-97.9%, 2.9-61.7% and 77.4-97.7%, respectively. ECG variables are risk factors for incident AF. The correlation between the ECG-derived AF predictors, especially P-wave indices, and underlying diseases and the effects of the reversal of the ECG-derived predictors on incident AF by treatment of comorbidities require further study.