Abstract 14057: P Wave Indices and Risk of Atrial Fibrillation: Cross-Cohort Assessments From the Framingham Heart Study and Atherosclerosis Risk in Communities Study
Introduction: P wave indices (PWI) have been employed in risk algorithms for atrial fibrillation (AF). PWI measure atrial electrical function and are quantified by duration, area, and amplitude. We hypothesized that cross-cohort pooling of PWI in the Framingham Heart Study (FHS) and Atherosclerosis Risk in Communities (ARIC) Study would provide greater evidence for their associations with AF.
Methods: In FHS and ARIC we quantified PWI similarly (MUSE, General Electric) from 12-lead ECGs performed at FHS Original Cohort examination 20 (1986-90), Offspring Cohort examination 6 (1995-98), Third Generation examination 1 (2002-05) and ARIC visit 4 (1996-98). Participants with AF/flutter, pre-excitation, use of antiarrhythmic or AV nodal blocking agents, or missing relevant covariates were excluded in both cohorts. We employed Cox models adjusted for identical covariates in both cohorts (except for race in ARIC) to examine PWI and AF risk.
Results: Following exclusions, 3110 (age 62.6±9.8, 57% women) FHS and 8254 (age 62.3±5.6, 57% women, 20.3% black race) ARIC participants were eligible. Over 10-year follow-up, 217 FHS and 458 ARIC participants had incident AF. Associations of the PWI at ≥ 95th percentile compared to <95th are shown in the figure. In pooled multivariable-adjusted meta-analysis, PR interval (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.04 to 1.85) and P wave duration (HR, 1.60; 95% CI, 1.24 to 2.06) were significantly associated with AF. P wave area was marginally but not significantly related to AF (HR, 1.31; 95% CI, 0.95 to 1.80). The association of P wave terminal force with AF was highly significant in ARIC (HR, 2.13; 95% CI, 1.58 to 2.86) but not FHS (HR, 0.74; 95% CI, 0.43 to 1.28).
Conclusions: PWI are intermediate phenotypes for AF by describing atrial electrical function and adverse remodeling. Future work should determine the contributions of PWI for prediction of AF in clinical practice.
- © 2013 by American Heart Association, Inc.