P-Wave Duration in Lead aVR and the Risk of Atrial Fibrillation in Hypertension

Background Hypertension entails atrial remodeling that affect P‐wave (PW) duration on electrocardiogram (ECG). PW indices (e.g., variance, dispersion, and terminal force) are associated with a higher risk for atrial fibrillation (AF), but their calculation requires multiple measurements of PW durati...

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Published inAnnals of noninvasive electrocardiology Vol. 20; no. 2; pp. 167 - 174
Main Authors Francia, Pietro, Ricotta, Agnese, Balla, Cristina, Adduci, Carmen, Semprini, Lorenzo, Frattari, Alessandra, Modestino, Anna, Mercanti, Federico, Sensini, Isabella, Caprinozzi, Massimo, Tocci, Giuliano, Volpe, Massimo
Format Journal Article
LanguageEnglish
Published United States Blackwell Publishing Ltd 01.03.2015
John Wiley & Sons, Inc
John Wiley and Sons Inc
Subjects
Aged
atrial fibrillation
Atrial Fibrillation - complications
Atrial Fibrillation - physiopathology
aVR lead
Cardiac arrhythmia
Case-Control Studies
Electrocardiography - methods
Electrocardiography - statistics & numerical data
Female
Humans
Hypertension
Hypertension - complications
Hypertension - physiopathology
Male
Medical research
Older people
Original
P wave
Risk
atrial fibrillation
aVR lead
hypertension
P wave
Online AccessGet full text

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Abstract Background Hypertension entails atrial remodeling that affect P‐wave (PW) duration on electrocardiogram (ECG). PW indices (e.g., variance, dispersion, and terminal force) are associated with a higher risk for atrial fibrillation (AF), but their calculation requires multiple measurements of PW duration, limiting their use in clinical practice. We evaluated whether PW duration in specific ECG leads may identify patients with increased susceptibility to AF in a population of hypertensive patients. Methods In a case–control study, AF and control subjects were matched for age, sex, and left atrial (LA) dimensions. PW duration was measured from digitally stored ECGs. Logistic regression was used to assess the association of PW duration and indices with AF. Results We enrolled 44 hypertensive AF patients (16 paroxysmal and 28 persistent) and 44 hypertensive controls. AF and control subjects were matched for sex (males, n = 27), age (67 ± 8 years), LA diameter (40 ± 5 mm), and were comparable for left ventricular mass (45 ± 11 g/m2.7 vs 48 ± 12 g/m2.7, P = 0.19), ejection fraction (58 ± 7% in both groups), and prevalence of mild valvular heart disease (7% vs 5%; P = 0.64). PW duration in lead aVR was significantly higher in AF patients as compared with controls (115 ± 18 ms vs 101 ± 14 ms; P < 0.0001) and was the best independent predictor of AF in multivariable logistic regression (PW ≥ 100 ms: RR = 3.7; 95% CI: 1.3–10.3; P = 0.02). Conclusions Simple measurement of PW duration in lead aVR allows effective identification of AF patients in a population of hypertensives. Confirmation of this finding in a larger population would provide a simple and effective risk marker of AF in hypertensive patients.
AbstractList Hypertension entails atrial remodeling that affect P-wave (PW) duration on electrocardiogram (ECG). PW indices (e.g., variance, dispersion, and terminal force) are associated with a higher risk for atrial fibrillation (AF), but their calculation requires multiple measurements of PW duration, limiting their use in clinical practice. We evaluated whether PW duration in specific ECG leads may identify patients with increased susceptibility to AF in a population of hypertensive patients.BACKGROUNDHypertension entails atrial remodeling that affect P-wave (PW) duration on electrocardiogram (ECG). PW indices (e.g., variance, dispersion, and terminal force) are associated with a higher risk for atrial fibrillation (AF), but their calculation requires multiple measurements of PW duration, limiting their use in clinical practice. We evaluated whether PW duration in specific ECG leads may identify patients with increased susceptibility to AF in a population of hypertensive patients.In a case-control study, AF and control subjects were matched for age, sex, and left atrial (LA) dimensions. PW duration was measured from digitally stored ECGs. Logistic regression was used to assess the association of PW duration and indices with AF.METHODSIn a case-control study, AF and control subjects were matched for age, sex, and left atrial (LA) dimensions. PW duration was measured from digitally stored ECGs. Logistic regression was used to assess the association of PW duration and indices with AF.We enrolled 44 hypertensive AF patients (16 paroxysmal and 28 persistent) and 44 hypertensive controls. AF and control subjects were matched for sex (males, n = 27), age (67 ± 8 years), LA diameter (40 ± 5 mm), and were comparable for left ventricular mass (45 ± 11 g/m(2.7) vs 48 ± 12 g/m(2.7) , P = 0.19), ejection fraction (58 ± 7% in both groups), and prevalence of mild valvular heart disease (7% vs 5%; P = 0.64). PW duration in lead aVR was significantly higher in AF patients as compared with controls (115 ± 18 ms vs 101 ± 14 ms; P < 0.0001) and was the best independent predictor of AF in multivariable logistic regression (PW ≥ 100 ms: RR = 3.7; 95% CI: 1.3-10.3; P = 0.02).RESULTSWe enrolled 44 hypertensive AF patients (16 paroxysmal and 28 persistent) and 44 hypertensive controls. AF and control subjects were matched for sex (males, n = 27), age (67 ± 8 years), LA diameter (40 ± 5 mm), and were comparable for left ventricular mass (45 ± 11 g/m(2.7) vs 48 ± 12 g/m(2.7) , P = 0.19), ejection fraction (58 ± 7% in both groups), and prevalence of mild valvular heart disease (7% vs 5%; P = 0.64). PW duration in lead aVR was significantly higher in AF patients as compared with controls (115 ± 18 ms vs 101 ± 14 ms; P < 0.0001) and was the best independent predictor of AF in multivariable logistic regression (PW ≥ 100 ms: RR = 3.7; 95% CI: 1.3-10.3; P = 0.02).Simple measurement of PW duration in lead aVR allows effective identification of AF patients in a population of hypertensives. Confirmation of this finding in a larger population would provide a simple and effective risk marker of AF in hypertensive patients.CONCLUSIONSSimple measurement of PW duration in lead aVR allows effective identification of AF patients in a population of hypertensives. Confirmation of this finding in a larger population would provide a simple and effective risk marker of AF in hypertensive patients.
Hypertension entails atrial remodeling that affect P-wave (PW) duration on electrocardiogram (ECG). PW indices (e.g., variance, dispersion, and terminal force) are associated with a higher risk for atrial fibrillation (AF), but their calculation requires multiple measurements of PW duration, limiting their use in clinical practice. We evaluated whether PW duration in specific ECG leads may identify patients with increased susceptibility to AF in a population of hypertensive patients. In a case-control study, AF and control subjects were matched for age, sex, and left atrial (LA) dimensions. PW duration was measured from digitally stored ECGs. Logistic regression was used to assess the association of PW duration and indices with AF. We enrolled 44 hypertensive AF patients (16 paroxysmal and 28 persistent) and 44 hypertensive controls. AF and control subjects were matched for sex (males, n = 27), age (67 ± 8 years), LA diameter (40 ± 5 mm), and were comparable for left ventricular mass (45 ± 11 g/m(2.7) vs 48 ± 12 g/m(2.7) , P = 0.19), ejection fraction (58 ± 7% in both groups), and prevalence of mild valvular heart disease (7% vs 5%; P = 0.64). PW duration in lead aVR was significantly higher in AF patients as compared with controls (115 ± 18 ms vs 101 ± 14 ms; P < 0.0001) and was the best independent predictor of AF in multivariable logistic regression (PW ≥ 100 ms: RR = 3.7; 95% CI: 1.3-10.3; P = 0.02). Simple measurement of PW duration in lead aVR allows effective identification of AF patients in a population of hypertensives. Confirmation of this finding in a larger population would provide a simple and effective risk marker of AF in hypertensive patients.
Background Hypertension entails atrial remodeling that affect P-wave (PW) duration on electrocardiogram (ECG). PW indices (e.g., variance, dispersion, and terminal force) are associated with a higher risk for atrial fibrillation (AF), but their calculation requires multiple measurements of PW duration, limiting their use in clinical practice. We evaluated whether PW duration in specific ECG leads may identify patients with increased susceptibility to AF in a population of hypertensive patients. Methods In a case-control study, AF and control subjects were matched for age, sex, and left atrial (LA) dimensions. PW duration was measured from digitally stored ECGs. Logistic regression was used to assess the association of PW duration and indices with AF. Results We enrolled 44 hypertensive AF patients (16 paroxysmal and 28 persistent) and 44 hypertensive controls. AF and control subjects were matched for sex (males, n = 27), age (67 ± 8 years), LA diameter (40 ± 5 mm), and were comparable for left ventricular mass (45 ± 11 g/m2.7 vs 48 ± 12 g/m2.7, P = 0.19), ejection fraction (58 ± 7% in both groups), and prevalence of mild valvular heart disease (7% vs 5%; P = 0.64). PW duration in lead aVR was significantly higher in AF patients as compared with controls (115 ± 18 ms vs 101 ± 14 ms; P < 0.0001) and was the best independent predictor of AF in multivariable logistic regression (PW ≥ 100 ms: RR = 3.7; 95% CI: 1.3-10.3; P = 0.02). Conclusions Simple measurement of PW duration in lead aVR allows effective identification of AF patients in a population of hypertensives. Confirmation of this finding in a larger population would provide a simple and effective risk marker of AF in hypertensive patients.
Background Hypertension entails atrial remodeling that affect P‐wave (PW) duration on electrocardiogram (ECG). PW indices (e.g., variance, dispersion, and terminal force) are associated with a higher risk for atrial fibrillation (AF), but their calculation requires multiple measurements of PW duration, limiting their use in clinical practice. We evaluated whether PW duration in specific ECG leads may identify patients with increased susceptibility to AF in a population of hypertensive patients. Methods In a case–control study, AF and control subjects were matched for age, sex, and left atrial (LA) dimensions. PW duration was measured from digitally stored ECGs. Logistic regression was used to assess the association of PW duration and indices with AF. Results We enrolled 44 hypertensive AF patients (16 paroxysmal and 28 persistent) and 44 hypertensive controls. AF and control subjects were matched for sex (males, n = 27), age (67 ± 8 years), LA diameter (40 ± 5 mm), and were comparable for left ventricular mass (45 ± 11 g/m2.7 vs 48 ± 12 g/m2.7, P = 0.19), ejection fraction (58 ± 7% in both groups), and prevalence of mild valvular heart disease (7% vs 5%; P = 0.64). PW duration in lead aVR was significantly higher in AF patients as compared with controls (115 ± 18 ms vs 101 ± 14 ms; P < 0.0001) and was the best independent predictor of AF in multivariable logistic regression (PW ≥ 100 ms: RR = 3.7; 95% CI: 1.3–10.3; P = 0.02). Conclusions Simple measurement of PW duration in lead aVR allows effective identification of AF patients in a population of hypertensives. Confirmation of this finding in a larger population would provide a simple and effective risk marker of AF in hypertensive patients.
Author Balla, Cristina
Semprini, Lorenzo
Modestino, Anna
Mercanti, Federico
Frattari, Alessandra
Francia, Pietro
Caprinozzi, Massimo
Tocci, Giuliano
Sensini, Isabella
Ricotta, Agnese
Adduci, Carmen
Volpe, Massimo
AuthorAffiliation 2 I.R.C.C.S. Neuromed Pozzilli (IS) Italy
1 Division of Cardiology Department of Clinical and Molecular Medicine St. Andrea Hospital Sapienza University Rome Italy
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Keywords atrial fibrillation
aVR lead
hypertension
P wave
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Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: National implications for rhythm management and stroke prevention: The AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. J Am Med Assoc 2001;285:2370-2375.
Abe Y, Fukunami M, Yamada T, et al. Prediction of transition to chronic atrial fibrillation in patients with paroxysmal atrial fibrillation by signal-averaged electrocardiography: A prospective study. Circulation 1997;96:2612-2616.
Verdecchia P, Carini G, Circo A, et al. Left ventricular mass and cardiovascular morbidity in essential hypertension: The MAVI study. J Am Coll Cardiol 2001;38:1829-1835.
Steinberg JS, Zelenkofske S, Wong SC, et al. Value of the P-wave signal-averaged ECG for predicting atrial fibrillation after cardiac surgery. Circulation 1993;88:2618-2622.
Tsang TS, Gersh BJ, Appleton CP, et al. Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women. J Am Coll Cardiol 2002;40:1636-1644.
Gonna H, Gallagher MM, Guo XH, et al. P-wave abnormality predicts recurrence of atrial fibrillation after electrical cardioversion: A prospective study. Ann Noninvasive Electrocardiol 2014;19:57-62.
Kalus JS, Kluger J, Caron MF, et al. An evaluation of postoperative P-wave variables after cardiothoracic surgery. J Electrocardiol 2004;37:127-132.
Jurkko R, Vaananen H, Mantynen V, et al. High-resolution signal-averaged analysis of atrial electromagnetic characteristics in patients with paroxysmal lone atrial fibrillation. Ann Noninvasive Electrocardiol 2008;13:378-385.
George A, Arumugham PS, Figueredo VM. aVR-The forgotten lead. Exp Clin Cardiol 2010;15:e36-e44.
Holmqvist F, Husser D, Tapanainen JM, et al. Interatrial conduction can be accurately determined using standard 12-lead electrocardiography: Validation of P-wave morphology using electroanatomic mapping in man. Heart Rhythm 2008;5:413-418.
Choisy SC, Arberry LA, Hancox JC, et al. Increased susceptibility to atrial tachyarrhythmia in spontaneously hypertensive rat hearts. Hypertension 2007;49:498-505.
Deftereos S, Kossyvakis C, Efremidis M, et al. Interatrial conduction time and incident atrial fibrillation: A prospective cohort study. Heart Rhythm 2014;11(7):1095-1101.
Benjamin EJ, Levy D, Vaziri SM, et al. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. J Am Med Assoc 1994;271:840-844.
Lau YF, Yiu KH, Siu CW, et al. Hypertension and atrial fibrillation: Epidemiology, pathophysiology and therapeutic implications. J Hum Hypertens 2012;26:563-569.
Magnani JW, Williamson MA, Ellinor PT, et al. P wave indices: Current status and future directions in epidemiology, clinical, and research applications. Circ Arrhythm Electrophysiol 2009;2:72-79.
Nabauer M, Gerth A, Limbourg T, et al. The Registry of the German Competence Network on Atrial Fibrillation: Patient characteristics and initial management. Europace 2009;11:423-434.
Heijman J, Voigt N, Nattel S, et al. Cellular and molecular electrophysiology of atrial fibrillation initiation, maintenance, and progression. Circ Res 2014;114:1483-1499.
Chang IC, Austin E, Krishnan B, et al. Shorter minimum P-wave duration is associated with paroxysmal lone atrial fibrillation. J Electrocardiol 2014;47:106-112.
Platonov PG. Atrial conduction and atrial fibrillation: What can we learn from surface ECG? Cardiol J 2008;15:402-407.
Koide Y, Yotsukura M, Ando H, et al. Usefulness of P-wave dispersion in standard twelve-lead electrocardiography to predict transition from paroxysmal to persistent atrial fibrillation. Am J Cardiol 2008;102:573-577.
de Simone G, Daniels SR, Devereux RB, et al. Left ventricular mass and body size in normotensive children and adults: Assessment of allometric relations and impact of overweight. J Am Coll Cardiol 1992;20:1251-1260.
Blanche C, Tran N, Carballo D, et al. Usefulness of P-wave signal averaging to predict atrial fibrillation recurrences after electrical cardioversion. Ann Noninvase Electrocardiol 2014;19:266-272.
Platonov PG. P-wave morphology: Underlying mechanisms and clinical implications. Ann Noninvasive Electrocardiol 2012;17:161-169.
Betts TR, Roberts PR, et al. High-density mapping of left atrial endocardial activation during sinus rhythm and coronary sinus pacing in patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2004;15:1111-1117.
Mancia G, Fagard R, Narkiewicz K, et al. 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens 2013;31:1925-1938.
Nattel S, Burstein B, Dobrev D. Atrial remodeling and atrial fibrillation: Mechanisms and implications. Circ Arrhythm Electrophysiol 2008;1:62-73.
Tsao CW, Josephson ME, Hauser TH, et al. Accuracy of electrocardiographic criteria for atrial enlargement: Validation with cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2008;10:7-13.
Andrikopoulos GK, Dilaveris PE, Richter DJ, et al. Increased variance of P wave duration on the electrocardiogram distinguishes patients with idiopathic paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2000;23:1127-1132.
Bayes de Luna A, Platonov P, Cosio FG, et al. Interatrial blocks. A separate entity from left atrial enlargement: A consensus report. J Electrocardiol 2012;45:445-451.
Becker AE. How structurally normal are human atria in patients with atrial fibrillation? Heart Rhythm 2004;1:627-631.
Dilaveris PE, Gialafos EJ, Chrissos D, et al. Detection of hypertensive patients at risk for paroxysmal atrial fibrillation during sinus rhythm by computer-assisted P wave analysis. J Hypertens 1999;17:1463-1470.
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Snippet Background Hypertension entails atrial remodeling that affect P‐wave (PW) duration on electrocardiogram (ECG). PW indices (e.g., variance, dispersion, and...
Hypertension entails atrial remodeling that affect P-wave (PW) duration on electrocardiogram (ECG). PW indices (e.g., variance, dispersion, and terminal force)...
Background Hypertension entails atrial remodeling that affect P-wave (PW) duration on electrocardiogram (ECG). PW indices (e.g., variance, dispersion, and...
SourceID pubmedcentral
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SourceType Open Access Repository
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StartPage 167
SubjectTerms Aged
atrial fibrillation
Atrial Fibrillation - complications
Atrial Fibrillation - physiopathology
aVR lead
Cardiac arrhythmia
Case-Control Studies
Electrocardiography - methods
Electrocardiography - statistics & numerical data
Female
Humans
Hypertension
Hypertension - complications
Hypertension - physiopathology
Male
Medical research
Older people
Original
P wave
Risk
Title P-Wave Duration in Lead aVR and the Risk of Atrial Fibrillation in Hypertension
URI https://api.istex.fr/ark:/67375/WNG-CQ7M9PRC-D/fulltext.pdf
https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fanec.12197
https://www.ncbi.nlm.nih.gov/pubmed/25200638
https://www.proquest.com/docview/1667307991
https://www.proquest.com/docview/1668237203
https://pubmed.ncbi.nlm.nih.gov/PMC6931737
Volume 20
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