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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Electrocardiographic left atrial abnormalities predict cardiovascular mortality
Le Dung Ha1, Aaron F Grober2, Julia Hock3
1Department of Internal Medicine, Rochester General Hospital, Rochester, NY, United States.
Insights
Specific P-wave patterns on electrocardiograms, particularly a negative deflection ≤-100 μV or a duration ≥140 ms, are significantly associated with cardiovascular death (CVD). These findings offer valuable insights for risk stratification in clinical practice.
Area of Science:
- Cardiology
- Medical Diagnostics
- Public Health
Background:
- Electrocardiography (ECG) is crucial for diagnosing left atrial abnormalities.
- Current ECG criteria for P-wave abnormalities are variable and lack a definitive imaging gold standard.
- Understanding P-wave morphology associations with cardiovascular outcomes is essential for improved risk assessment.
Purpose of the Study:
- To determine the prevalence of different P-wave patterns on ECGs.
- To identify specific P-wave components associated with cardiovascular death (CVD).
- To enhance the diagnostic utility of ECG in predicting adverse cardiac events.
Main Methods:
- Retrospective analysis of 20,827 veterans undergoing ECGs between 1987 and 1999.
- Median follow-up duration of 17.8 years for CVD.
- Statistical analyses included ROC, Kaplan-Meier, and Cox Hazard models, adjusted for covariates.
Main Results:
- A negative P-wave deflection in V1 or V2 ≤-100 μV was significantly associated with CVD (adjusted HRs 2.9-4.1).
- Total P-wave duration ≥140 ms was independently associated with CVD (adjusted HR 2.2).
- These ECG findings demonstrated a strong correlation with increased risk of cardiovascular death.
Conclusions:
- Specific P-wave characteristics, including negative amplitude and prolonged duration, are independent predictors of CVD.
- These ECG findings provide valuable, quantifiable markers for cardiovascular risk stratification.
- The study highlights the potential for refining ECG interpretation to improve patient outcomes.
Objective:
Clinical utilization of electrocardiography for diagnosis of left atrial abnormalities is hampered by variable P-wave morphologies, multiple empiric criteria, and lack of an imaging "gold standard". Our aim was to determine the prevalence of P-wave patterns and demonstrate which components have associations with cardiovascular death (CVD).
Methods:
This is a retrospective analysis of 20,827 veterans <56 years of age who underwent electrocardiograms at a Veteran's Affairs Medical Center from 1987 to 1999, followed for a median duration of 17.8 years for CVD. Receiver Operating Characteristic, Kaplan-Meier and Cox Hazard analyses were applied, the latter with adjustment for age, gender and electrocardiography abnormalities.
Results:
The mean age was 43.3 ± 8 years, and 888 CVD (4.3%) occurred. A single positive deflection of the P-wave (Pattern 1) was present in 29% for V1 and 81% for V2. A singular negative P-wave (Pattern 2) was present in 4.6% for V1 and 1.6% in V2. A P-wave with an upward component followed by downward component (Pattern 3) was present in 64.5% for V1 and 17.5% for V2. When the downward component in Patterns 2 and/or 3 is at least -100 μV, a significant association is observed with CVD (adjusted hazard ratios [HRs] 2.9-4.1, P < 0.001). Total P-wave duration ≥140 ms was also associated with CVD (adjusted HR 2.2, P < 0.001).
Conclusions:
A negative P-wave in V1 or V2 ≤-100 μV, and P-wave with a duration of ≥140 ms, all have independent and significant associations with CVD, with HRs comparable to other electrocardiography abnormalities.
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