title: ECG Features Associated With Adverse Cardiovascular Outcomes in Patients With Atrial Fibrillation: A Combined AFFIRM and AF-CHF Analysis.
abstract: BACKGROUND
  The association between standard parameters from a simple 12-lead ECG (i.e., QRS duration and PR, JT, and QT intervals) and adverse cardiovascular outcomes (cardiovascular mortality, all-cause mortality, arrhythmic mortality, and hospitalizations) in patients with a history of atrial fibrillation (AF) has not been previously studied.
  
  
  RESULTS
  A pooled analysis of patient-level data was conducted on 5,436 patients, age 68.2 ± 8.3 years, 34.8% female, with a history of non-permanent AF randomized in AFFIRM and AF-CHF trials. The predictive value of ECG parameters was assessed in AF and sinus rhythm in multivariate Cox regression models. During a follow-up of 40.8 ± 16.3 months, QRS duration >120 milliseconds was independently associated with all-cause mortality (hazard ratio [HR] 1.46, 95% confidence interval [CI; 1.21-1.76] in AF, P < 0.001), cardiovascular mortality (HR 1.75, 95% CI (1.15-2.65) in sinus rhythm, P = 0.009; HR 1.56, 95% CI [1.27-1.93] in AF, P < 0.001), arrhythmic mortality (HR 1.90, 95% CI [1.09-3.32] in sinus, P = 0.024; HR 1.84, 95% CI [1.35-2.51] in AF, P < 0.001), any hospitalization (HR 1.15, 95% CI [1.02-1.29] in AF, P = 0.027), and cardiovascular hospitalization (HR 1.21, 95% CI [1.06-1.37] in AF; P = 0.004). Increased PR interval (>200 milliseconds) was independently associated with cardiovascular (HR 1.56, 95% CI [1.11-2.21], P = 0.010) and arrhythmic (HR 1.91, 95% CI [1.14-3.18], P = 0.004) mortality. The JT and QTc intervals were not predictive of mortality.
  
  
  CONCLUSIONS
  Simple parameters from standard ECGs are significantly and independently associated with adverse cardiovascular outcomes in patients with a history of AF.
authors.affiliation: Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Andrade
authors.affiliation: Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Denis
authors.initials: D
authors.lastname: Roy
authors.affiliation: Libin Cardiovascular Institute, Calgary, Alberta, Canada.
authors.forename: D George
authors.initials: DG
authors.lastname: Wyse
authors.affiliation: St. Michael's Hospital, University of Toronto, Toronto, Ontario.
authors.forename: Paul
authors.initials: P
authors.lastname: Dorian
authors.affiliation: Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Mario
authors.initials: M
authors.lastname: Talajic
authors.affiliation: Montreal Heart Institute Coordinating Center, Montreal, Quebec, Canada.
authors.forename: Hugues
authors.initials: H
authors.lastname: Leduc
authors.affiliation: Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Julia
authors.initials: J
authors.lastname: Cadrin-Tourigny
authors.affiliation: Montreal Heart Institute Coordinating Center, Montreal, Quebec, Canada.
authors.forename: Azadeh
authors.initials: A
authors.lastname: Shohoudi
authors.affiliation: Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Laurent
authors.initials: L
authors.lastname: Macle
authors.affiliation: Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Bernard
authors.initials: B
authors.lastname: Thibault
authors.affiliation: Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Guerra
authors.affiliation: Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Léna
authors.initials: L
authors.lastname: Rivard
authors.affiliation: Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: Dubuc
authors.affiliation: Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.|Montreal Heart Institute Coordinating Center, Montreal, Quebec, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D002170:Canada / Q000453:epidemiology; D002304:Cardiac Pacing, Artificial / Q000401:mortality* / Q000706:statistics & numerical data; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
keywords: AF-CHF trial; AFFIRM trial; atrial fibrillation; electrocardiography; hospitalization; mortality