title: Incremental changes in QRS duration predict mortality in patients with atrial fibrillation.
abstract: BACKGROUND
  The purpose of this study was to evaluate serial changes in QRS duration in the 12-lead electrocardiogram (ECG) and their prognostic value in patients with atrial fibrillation (AF).
  
  
  METHODS
  Retrospective evaluation of the 12-lead ECG was performed in 822 patients with AF. Inclusion criteria included AF in two sequential ECGs and an echocardiogram obtained within 7 days of the second ECG. The mean age of the 228 patients enrolled in the study was 71.2+/-12.9 and 45.6% were females. Nearly half of the patients had hypertension (49.5%) and a history of heart failure (44.7%). The patients were followed for 21+/-19 months, and the end point was all-cause mortality.
  
  
  RESULTS
  Cox proportional hazards analysis demonstrated that the independent predictors of mortality in AF patients were age, renal insufficiency, a history of stroke, heart rate, incremental QRS prolongation (P=0.0418), and the absence of warfarin use. Patients with QRS prolongation>15 ms had a worse prognosis than those with QRS prolongation<or=15 ms (P=0.0019).
  
  
  CONCLUSIONS
  A progressive increase in QRS duration predicted a poor prognosis in patients with AF in our study. A prospective study is needed to substantiate the prognostic value of QRS prolongation in AF patients.
authors.affiliation: Department of Cardiology, Division of Cardiology, En Chu Kong Hospital, Taipei, Taiwan.
authors.forename: Yueh-Juh
authors.initials: YJ
authors.lastname: Lin
authors.forename: Yen-Bin
authors.initials: YB
authors.lastname: Liu
authors.forename: Ching-Chi
authors.initials: CC
authors.lastname: Chu
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000401:mortality*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004562:Electrocardiography / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology