P-wave duration and the risk of atrial fibrillation: Results from the Copenhagen ECG Study.
BACKGROUND
Results on the association between P-wave duration and the risk of atrial fibrillation (AF) are conflicting.


OBJECTIVE
The purpose of this study was to obtain a detailed description of the relationship between P-wave duration and the risk of AF.


METHODS
Using computerized analysis of electrocardiograms from a large primary care population, we evaluated the association between P-wave duration and the risk of AF. Secondary end-points were death from cardiovascular causes and putative ischemic stroke. Data on drug use, comorbidity, and outcomes were collected from administrative registries.


RESULTS
A total of 285,933 individuals were included. During median follow-up period of 6.7 years, 9550 developed AF, 9371 died of a cardiovascular cause, and 8980 had a stroke. Compared with the reference group (100-105 ms), individuals with very short (≤89 ms; hazard ratio [HR] 1.60, 95% confidence interval [CI] 1.41-1.81), intermediate (112-119 ms; HR 1.22, 95% CI 1.13-1.31), long (120-129 ms; HR 1.50, 95% CI 1.39-1.62), and very long P-wave duration (≥130 ms; HR 2.06, 95% CI 1.89-2.23) had an increased risk of incident AF. With respect to death from cardiovascular causes, we found an increased risk for very short (≤89 ms; HR 1.20, 95% CI 1.06-1.34), long (120-129 ms; HR 1.11, 95% CI 1.04-1.19), and very long P-wave duration (≥130 ms; HR 1.30, 95% CI 1.21-1.40) compared with the reference group (106-111 ms). Similar but weaker associations were found between P-wave duration and the risk of putative ischemic stroke.


CONCLUSIONS
In a large primary care population we found both short and long P-wave duration to be robustly associated with an increased risk of AF.
Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark; Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. Electronic address: jonas.bille.nielsen@gmail.com.
Jonas B
JB
Nielsen
Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Jørgen T
JT
Kühl
Copenhagen General Practitioners' Laboratory, Copenhagen, Denmark.
Adrian
A
Pietersen
Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
Claus
C
Graff
Copenhagen General Practitioners' Laboratory, Copenhagen, Denmark.
Bent
B
Lind
Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
Johannes J
JJ
Struijk
Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark; Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Morten S
MS
Olesen
Department of Medicine I, University Hospital Munich, Campus Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
Moritz F
MF
Sinner
Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark; Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Troels N
TN
Bachmann
Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark; Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Stig
S
Haunsø
Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Herlev, Denmark.
Børge G
BG
Nordestgaard
Cardiac Arrhythmia Service, Cardiovascular Research Center & Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts.
Patrick T
PT
Ellinor
Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark; Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Jesper H
JH
Svendsen
Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Klaus F
KF
Kofoed
Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Lars
L
Køber
Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark; Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Anders G
AG
Holst
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D003718:Denmark / Q000453:epidemiology; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012042:Registries; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014057:Tomography, X-Ray Computed
Atrial fibrillation; Death; Electrocardiography; P-wave; Stroke