P-wave characteristics as electrocardiographic markers of atrial abnormality in prediction of incident atrial fibrillation - The Malmö Preventive Project

Maria A Baturova; Gustav Cornefjord; Jonas Carlson; Linda S B Johnson; J Gustav Smith; Pyotr G Platonov

doi:10.1016/j.jelectrocard.2023.12.003

P-wave characteristics as electrocardiographic markers of atrial abnormality in prediction of incident atrial fibrillation - The Malmö Preventive Project

J Electrocardiol. 2024 Jan-Feb:82:125-130. doi: 10.1016/j.jelectrocard.2023.12.003. Epub 2023 Dec 14.

Authors

Maria A Baturova¹, Gustav Cornefjord², Jonas Carlson³, Linda S B Johnson⁴, J Gustav Smith⁵, Pyotr G Platonov⁶

Affiliations

¹ Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, SE-221 85 Lund, Sweden; Research Park, Saint Petersburg University, 7/9 Universitetskaya Emb., 199034 Saint Petersburg, Russia. Electronic address: maria.baturova@med.lu.se.
² Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, SE-221 85 Lund, Sweden.
³ Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, SE-221 85 Lund, Sweden. Electronic address: jonas.carlson@med.lu.se.
⁴ Department of Clinical Sciences, Lund University, SE-202 13 Malmö, Sweden; Department of Imaging and Functional Studies, Skåne University Hospital, SE-205 02 Malmö, Sweden. Electronic address: linda.johnson@med.lu.se.
⁵ Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, SE-221 85 Lund, Sweden; The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Sweden; Wallenberg Center for Molecular Medicine and Lund University Diabetes Center, Lund University, SE-221 84 Lund, Sweden; Department of Cardiology, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden. Electronic address: gustav.smith@med.lu.se.
⁶ Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, SE-221 85 Lund, Sweden. Electronic address: pyotr.platonov@med.lu.se.

PMID: 38128157
DOI: 10.1016/j.jelectrocard.2023.12.003

Abstract

Background: P-wave indices reflect atrial abnormalities contributing to atrial fibrillation (AF). We aimed to assess a comprehensive set of P-wave characteristics for prediction of incident AF in a population-based setting.

Methods: Malmö Preventative Project (MPP) participants were reexamined in 2002-2006 with electrocardiographic (ECG) and echocardiographic examinations and followed for 5 years. AF-free subjects (n = 983, age 70 ± 5 years, 38% females) with sinus rhythm ECGs were included in the study. ECGs were digitally processed using the Glasgow algorithm. P-wave duration, axis, dispersion, P-terminal force in lead V1 and interatrial block (IAB) were evaluated. ECG risk score combining the morphology, voltage and length of P-wave (MVP score) was calculated. New-onset diagnoses of AF were obtained from nation-wide registers.

Results: During follow up, 66 patients (7%) developed AF. After adjustment for age and gender, the independent predictors of AF were abnormal P-wave axis > 75° (HR 1.63 CI95% 1.95-11.03) and MVP score 4 (HR 6.17 CI 95% 1.76-21.64), both correlated with LA area: Person r - 0.146, p < 0.001 and 0.192, p < 0.001 respectively. Advanced IAB (aIAB) with biphasic P-wave morphology in leads III and aVF was the most prevalent variant of aIAB and predicted AF in a univariate model (HR 2.59 CI 95% 1.02-6.58).

Conclusion: P-wave frontal axis and MVP score are ECG-based AF predictors in the population-based cohort. Our study provides estimates for prevalence and prognostic importance of different variants of aIAB, providing a support to use biphasic P-wave morphology in lead aVF as the basis for aIAB definition.

Keywords: Atrial fibrillation; Interatrial block; MVP score; P-wave.

MeSH terms

Aged
Atrial Fibrillation* / diagnosis
Atrial Fibrillation* / epidemiology
Echocardiography
Electrocardiography
Female
Heart Atria
Humans
Interatrial Block / diagnosis
Interatrial Block / epidemiology
Male