Electrocardiogram P-Wave Dispersion and New-Onset Atrial Fibrillation: A Nested Case-Control Study

This study aimed to investigate the association between electrocardiogram (ECG) P-wave dispersion (Pd) in sinus rhythm and the risk of new-onset atrial fibrillation (NAF) within one year, to identify high-risk individuals earlier and improve clinical outcomes.

(1) This retrospective nested case-control study included patients diagnosed with NAF at Changzhou First People's Hospital between July 2022 and June 2023. Cases were defined as individuals without a previous atrial fibrillation (AF) diagnosis who developed NAF regardless of symptom status. Controls were matched 1:3 by age and sex from individuals with sinus rhythm during the same period. (2) Using the date of the NAF diagnosis as the index date, then ECGs, echocardiographic data, laboratory tests, and basic clinical characteristics in the sinus rhythm were collected via the electronic medical record system for all subjects within one year post-index date. (3) Differences in ECG parameters, echocardiographic parameters, blood biological indicators, and basic clinical characteristics in the sinus rhythm were compared between the two groups. (4) Conditional logistic regression models were used to evaluate the association between relevant ECG indicators and NAF, with curve fitting performed using generalized additive models (GAMs).

(1) A total of 824 participants were enrolled, including 206 NAF cases and 618 matched controls. (2) A comparison between groups identified significantly higher diastolic blood pressure, glycated hemoglobin A1c, serum creatinine, P-wave duration, Pd, and left atrial diameter in the NAF group than the control group; meanwhile, uric acid, total cholesterol, high-density lipoprotein, and low-density lipoprotein were significantly lower (all p < 0.05). (3) In fully adjusted conditional logistic regression models, increased Pd was independently associated with a higher risk of NAF within one year (odds ratio (OR): 1.149; 95% confidence interval (CI): 1.099-1.202; p < 0.001). Curve fitting demonstrated a positive correlation between Pd and the risk of NAF.

ECG Pd in the sinus rhythm was independently and positively associated with the risk of NAF within one year.