P wave and the development of atrial fibrillation.
BACKGROUND
Terminal P-wave inversion in lead V(1) representing left atrial overload has been considered a precursor of atrial fibrillation (AF).


OBJECTIVE
The purpose of this study was to determine whether this P-wave morphologic characteristic can predict the development of AF.


METHODS
Digital analysis of 12-lead ECGs was performed to enroll patients with P terminal force > or =0.06 s x 2 mm in lead V(1) from among a database of 308,391 ECG recordings. The prognostic value of ECG characteristics for developing AF was determined.


RESULTS
A total of 78 patients (mean age 52 +/- 19 years) with left atrial overload were chosen from among 102,065 patients in the database. During mean follow-up of 43 months, 15 (19%) patients developed AF (AF group) versus 63 (81%) patients who did not (non-AF group). No significant difference was noted between the AF and non-AF groups with regard to the area, duration, and amplitude of the P-wave terminal portion in lead V(1). In contrast, the area, duration, and amplitude of the P-wave initial portion in the same lead were significantly greater in the AF group than in the non-AF group (114.6 +/- 73.0 microV x ms vs 73.1 +/- 59.3 microV x ms, 42.2 +/- 12.4 ms vs 35.7 +/- 10.1 ms, and 94.0 +/- 39.9 microV vs 68.8 +/- 49.4 microV, respectively; P <.05 for each). Multivariate analysis confirmed that the area of the P-wave initial portion was independently associated with the development of AF (hazard ratio 4.02, 95% confidence interval 1.25-17.8; P = .018).


CONCLUSIONS
P-wave initial portion in lead V(1) was an independent risk stratifier of AF development in patients with marked left atrial overload.
Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan.
Katsuya
K
Ishida
Hideki
H
Hayashi
Akashi
A
Miyamoto
Yoshihisa
Y
Sugimoto
Makoto
M
Ito
Yoshitaka
Y
Murakami
Minoru
M
Horie
D000328:Adult; D001281:Atrial Fibrillation / Q000209:etiology*; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria; D006331:Heart Diseases / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment