Background

P-wave indices reflect atrial abnormalities contributing to atrial fibrillation (AF). We aimed to assess a comprehensive set of P-wave characteristics for prediction of incident AF in a population-based setting.

Methods

Malmö Preventative Project (MPP) participants were reexamined in 2002–2006 with electrocardiographic (ECG) and echocardiographic examinations and followed for 5 years. AF-free subjects (n = 983, age 70 ± 5 years, 38% females) with sinus rhythm ECGs were included in the study. ECGs were digitally processed using the Glasgow algorithm. P-wave duration, axis, dispersion, P-terminal force in lead V1 and interatrial block (IAB) were evaluated. ECG risk score combining the morphology, voltage and length of P-wave (MVP score) was calculated. New-onset diagnoses of AF were obtained from nation-wide registers.

Results

During follow up, 66 patients (7%) developed AF. After adjustment for age and gender, the independent predictors of AF were abnormal P-wave axis > 75° (HR 1.63 CI95% 1.95–11.03) and MVP score 4 (HR 6.17 CI 95% 1.76–21.64), both correlated with LA area: Person r − 0.146, p < 0.001 and 0.192, p < 0.001 respectively. Advanced IAB (aIAB) with biphasic P-wave morphology in leads III and aVF was the most prevalent variant of aIAB and predicted AF in a univariate model (HR 2.59 CI 95% 1.02–6.58).

Conclusion

P-wave frontal axis and MVP score are ECG-based AF predictors in the population-based cohort. Our study provides estimates for prevalence and prognostic importance of different variants of aIAB, providing a support to use biphasic P-wave morphology in lead aVF as the basis for aIAB definition.

中文翻译：

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P 波特征作为心房异常的心电图标记，用于预测房颤事件 – 马尔默预防项目

背景

P 波指数反映了导致心房颤动 (AF) 的心房异常。我们的目的是评估一套全面的 P 波特征，以预测基于人群的环境中发生的 AF 事件。

方法

马尔默预防项目 (MPP) 参与者于 2002 年至 2006 年接受了心电图 (ECG) 和超声心动图检查的重新检查，并随访了 5 年。 研究中包括具有窦性心律心电图的无 AF 受试者（n = 983，年龄 70 ± 5 岁，38% 女性）。心电图使用格拉斯哥算法进行数字处理。评估了P 波持续时间、电轴、色散、V1 导联 P 端力和房间传导阻滞 (IAB)。结合 P 波的形态、电压和长度计算心电图风险评分（MVP 评分）。新发 AF 的诊断是从全国登记册中获得的。

结果

在随访期间，66 名患者 (7%) 出现房颤。调整年龄和性别后，AF 的独立预测因素是 P 波轴异常 > 75° (HR 1.63 CI95% 1.95–11.03) 和 MVP 评分 4 (HR 6.17 CI 95% 1.76–21.64)，两者均与 LA 面积相关：分别为人 r − 0.146，p  < 0.001 和 0.192，p < 0.001。III 导联和 aVF 中具有双相 P 波形态的高级 IAB (aIAB) 是 aIAB 最常见的变体，可在单变量模型中预测 AF（HR 2.59 CI 95% 1.02–6.58）。

结论

P 波额轴和 MVP 评分是基于人群的队列中基于心电图的 AF 预测因子。我们的研究提供了 aIAB 不同变体的患病率和预后重要性的估计，为使用导联 aVF 中的双相 P 波形态作为 aIAB 定义的基础提供了支持。