title: P-pulmonale and the development of atrial fibrillation.
abstract: BACKGROUND
  P wave ≥0.25mV in inferior leads (P pulmonale) occurs in chronic lung diseases that underlie atrial fibrillation (AF). The purpose of this study was to elucidate the prognostic value of P pulmonale for development of AF.
  
  
  RESULTS
  Digital analysis of 12-lead electrocardiogram (ECG) was conducted to enroll patients with P pulmonale from among a database containing 308,391 ECGs. In a total of 591 patients (382 men; 56.4±14.8 years) with P pulmonale (follow-up, 46.7±65.6 months), AF occurred in 61 patients (AF group), but did not occur in 530 patients (non-AF group). Male gender was significantly more prevalent in the AF group than in the non-AF group (80.3% vs. 62.8%, P=0.0047). P-wave duration and PQ interval were significantly longer in the AF group than in the non-AF group (115.4±17.2ms vs. 107.0±17.2ms, P=0.0003 and 166.3±23.9ms vs. 153.2±25.4ms, P=0.0001, respectively). In the total patient group, multivariate Cox proportional-hazards analysis confirmed that male gender (hazard ratio [HR], 2.24; 95% confidence interval [CI]: 1.02-5.49; P=0.045), PQ interval >150ms (HR, 6.89; 95% CI: 2.39-29.15; P<0.0001), and P-wave axis <74° (HR, 2.55; 95% CI: 1.20-5.41; P=0.016) were associated with AF development. In medication-free patients (n=400), only PQ interval >150ms (HR, 9.26; 95% CI: 1.75-170.65; P=0.0055) was independently and significantly associated with AF development.
  
  
  CONCLUSIONS
  PQ interval is the strongest stratifier for AF development in P pulmonale.
authors.affiliation: Departments of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science.
authors.forename: Hideki
authors.initials: H
authors.lastname: Hayashi
authors.forename: Akashi
authors.initials: A
authors.lastname: Miyamoto
authors.forename: Tamiro
authors.initials: T
authors.lastname: Kawaguchi
authors.forename: Nobu
authors.initials: N
authors.lastname: Naiki
authors.forename: Joel Q
authors.initials: JQ
authors.lastname: Xue
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Murakami
authors.forename: Minoru
authors.initials: M
authors.lastname: Horie
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology*; D012727:Sex Characteristics