The QT interval and risk of incident atrial fibrillation

Abstract

Background: Abnormal atrial repolarization is important in the development of atrial fibrillation (AF), but no direct measurement is available in clinical medicine.

Objective: To determine whether the QT interval, a marker of ventricular repolarization, could be used to predict incident AF.

Methods: We examined a prolonged QT interval corrected by using the Framingham formula (QT(Fram)) as a predictor of incident AF in the Atherosclerosis Risk in Communities (ARIC) study. The Cardiovascular Health Study (CHS) and Health, Aging, and Body Composition (ABC) study were used for validation. Secondary predictors included QT duration as a continuous variable, a short QT interval, and QT intervals corrected by using other formulas.

Results: Among 14,538 ARIC study participants, a prolonged QT(Fram) predicted a roughly 2-fold increased risk of AF (hazard ratio [HR] 2.05; 95% confidence interval [CI] 1.42-2.96; P < .001). No substantive attenuation was observed after adjustment for age, race, sex, study center, body mass index, hypertension, diabetes, coronary disease, and heart failure. The findings were validated in Cardiovascular Health Study and Health, Aging, and Body Composition study and were similar across various QT correction methods. Also in the ARIC study, each 10-ms increase in QT(Fram) was associated with an increased unadjusted (HR 1.14; 95% CI 1.10-1.17; P < .001) and adjusted (HR 1.11; 95% CI 1.07-1.14; P < .001) risk of AF. Findings regarding a short QT interval were inconsistent across cohorts.

Conclusions: A prolonged QT interval is associated with an increased risk of incident AF.

Keywords: AF; ARIC; Atherosclerosis Risk in Communities; Atrial fibrillation; CHF; CHS; CI; Cardiovascular Health Study; ECG; Electrocardiogram; Epidemiology; HR; HTN; Health ABC; Health, Aging, and Body Composition; LQTS; QT corrected by using the Framingham formula; QT interval; QT(Fram); QTc; REGARDS; Reasons for Geographic and Racial Differences in Stroke; Risk; atrial fibrillation; confidence interval; congestive heart failure; corrected QT interval; electrocardiogram; hazard ratio; hypertension; long QT syndrome.