Elsevier

American Heart Journal

Volume 158, Issue 4, October 2009, Pages 622-628
American Heart Journal

Clinical Investigation
Electrophysiology
Electrocardiographic predictors of atrial fibrillation

https://doi.org/10.1016/j.ahj.2009.08.002Get rights and content

Background

Atrial fibrillation (AF) is the most prevalent arrhythmia in the United States and accounts for more than 750,000 strokes per year. Noninvasive predictors of AF may help identify patients at risk of developing AF. Our objective was to identify the electrocardiographic characteristics associated with onset of AF.

Methods

This was a retrospective cohort analysis of 42,751 patients with electrocardiograms (ECGs) ordered by physician's discretion and analyzed using a computerized system. The population was followed for detection of AF on subsequent ECGs. Cox proportional hazard regression analysis was performed to test the association between these ECG characteristics and development of AF.

Results

For a mean follow-up of 5.3 years, 1,050 (2.4%) patients were found to have AF on subsequent ECG recordings. Several ECG characteristics, such as P-wave dispersion (the difference between the widest and narrowest P waves), premature atrial contractions, and an abnormal P axis, were predictive of AF with hazard ratio of approximately 2 after correcting for age and sex. P-wave index, the SD of P-wave duration across all leads, was one of the strongest predictors of AF with a concordance index of 0.62 and a hazard ratio of 2.7 (95% CI 2.1-3.3) for a P-wave index >35. These were among the several independently predictive markers identified on multivariate analysis.

Conclusions

Several ECG markers are independently predictive of future onset of AF. The P index, a measurement of disorganized atrial depolarization, is one of the strongest predictors of AF. The ECG contains valuable prognostic information that can identify patients at risk of AF.

Section snippets

Study design

The Palo Alto Veterans Affairs Health Care System uses a computerized ECG system (GE Marquette) to collect, store, and analyze ECGs. This system has been validated by both the US Food and Drug Administration and the European Community and is widely used across the world. The current study involved the retrospective analysis of 45,855 initial ECGs obtained between March 1987 and July 2000 that were ordered for usual clinical indications. The 3,104 patients found to be in AF on the initial ECG

Baseline demographics and ECG characteristics

There were a total of 42,751 patients with an initial ECG demonstrating absence of AF. These patients were followed for an average of 5.3 years and received a mean of 3.2 follow-up ECGs. Fifty-three percent of patients received 1 ECG, 15% had 2 ECGs, and 32% had more than 2 ECGs. The period between ECGs was, on average, 3.0 years. During this period, 1,050 (2.4%) patients were found to have AF on a subsequent ECG. Table I presents the baseline demographic information of patients who maintained

Discussion

Atrial fibrillation has been growing at a pace rapid enough to be labeled an epidemic.34 Because the population continues to grow and age, the prevalence of AF and its heavy burden on health care will continue to surge. Novel therapies such as better-tolerated anticoagulants, more selective antiarrhythmics, and catheter interventions are evolving and will make treatment of AF less challenging in the future.

As these therapies for AF become safer and more affordable, screening for AF will gain

References (36)

  • FeinbergW.M. et al.

    Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications

    Arch Intern Med

    (1995)
  • WolfP.A. et al.

    Impact of atrial fibrillation on mortality, stroke, and medical costs

    Arch Intern Med

    (1998)
  • BenjaminE.J. et al.

    Impact of atrial fibrillation on the risk of death: the Framingham Heart Study

    Circulation

    (1998)
  • StaszewskiJ.

    Atrial fibrillation characteristics in patients with ischaemic stroke

    Kardiol Pol

    (2007)
  • ArankiS.F. et al.

    Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources

    Circulation

    (1996)
  • DaoudE.G. et al.

    Preoperative amiodarone as prophylaxis against atrial fibrillation after heart surgery

    N Engl J Med

    (1997)
  • HalonenJ. et al.

    Corticosteroids for the prevention of atrial fibrillation after cardiac surgery: a randomized controlled trial

    Jama

    (2007)
  • PattiG. et al.

    Randomized trial of atorvastatin for reduction of postoperative atrial fibrillation in patients undergoing cardiac surgery: results of the ARMYDA-3 (Atorvastatin for Reduction of MYocardial Dysrhythmia After cardiac surgery) study

    Circulation

    (2006)

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