P-wave duration in lead aVR and the risk of Atrial fibrillation in Hypertension

Pietro Francia, Agnese Ricotta, Cristina Balla, Carmen Adduci, Lorenzo Semprini, Alessandra Frattari, Anna Modestino, Federico Mercanti, Isabella Sensini, Massimo Caprinozzi, Giuliano Tocci, Massimo Volpe

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)167-174
Number of pages8
JournalAnnals of Noninvasive Electrocardiology
Volume20
Issue number2
DOIs
Publication statusPublished - Mar 1 2015

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Atrial Fibrillation
Hypertension
Electrocardiography
Logistic Models
Lead
Atrial Remodeling
Population
Heart Valve Diseases
Case-Control Studies

Keywords

  • atrial fibrillation
  • aVR lead
  • hypertension
  • P wave

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • Medicine(all)

Cite this

P-wave duration in lead aVR and the risk of Atrial fibrillation in Hypertension. / Francia, Pietro; Ricotta, Agnese; Balla, Cristina; Adduci, Carmen; Semprini, Lorenzo; Frattari, Alessandra; Modestino, Anna; Mercanti, Federico; Sensini, Isabella; Caprinozzi, Massimo; Tocci, Giuliano; Volpe, Massimo.

In: Annals of Noninvasive Electrocardiology, Vol. 20, No. 2, 01.03.2015, p. 167-174.

Research output: Contribution to journalArticle

Francia, P, Ricotta, A, Balla, C, Adduci, C, Semprini, L, Frattari, A, Modestino, A, Mercanti, F, Sensini, I, Caprinozzi, M, Tocci, G & Volpe, M 2015, 'P-wave duration in lead aVR and the risk of Atrial fibrillation in Hypertension', Annals of Noninvasive Electrocardiology, vol. 20, no. 2, pp. 167-174. https://doi.org/10.1111/anec.12197
Francia, Pietro ; Ricotta, Agnese ; Balla, Cristina ; Adduci, Carmen ; Semprini, Lorenzo ; Frattari, Alessandra ; Modestino, Anna ; Mercanti, Federico ; Sensini, Isabella ; Caprinozzi, Massimo ; Tocci, Giuliano ; Volpe, Massimo. / P-wave duration in lead aVR and the risk of Atrial fibrillation in Hypertension. In: Annals of Noninvasive Electrocardiology. 2015 ; Vol. 20, No. 2. pp. 167-174.
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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.",
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T1 - P-wave duration in lead aVR and the risk of Atrial fibrillation in Hypertension

AU - Francia, Pietro

AU - Ricotta, Agnese

AU - Balla, Cristina

AU - Adduci, Carmen

AU - Semprini, Lorenzo

AU - Frattari, Alessandra

AU - Modestino, Anna

AU - Mercanti, Federico

AU - Sensini, Isabella

AU - Caprinozzi, Massimo

AU - Tocci, Giuliano

AU - Volpe, Massimo

PY - 2015/3/1

Y1 - 2015/3/1

N2 - 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.

AB - 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.

KW - atrial fibrillation

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KW - hypertension

KW - P wave

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