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P‐wave durations from automated electrocardiogram analysis to predict atrial fibrillation and mortality in heart failure

Zhou, Jiandong, Li, Andrew, Tan, Martin, Lam, Matthew Chung Yan, Hung, Lok Tin, Siu, Ronald Wing Hei, Lee, Sharen, Lakhani, Ishan, Chan, Jeffrey Shi Kai, Bin Waleed, Khalid, and others. (2023) P‐wave durations from automated electrocardiogram analysis to predict atrial fibrillation and mortality in heart failure. ESC Heart Failure, 10 (2). pp. 872-883. ISSN 2055-5822. (doi:10.1002/ehf2.14230) (KAR id:99076)


Background: P-wave indices have been used to predict incident atrial fibrillation (AF), stroke, and mortality. However, such indices derived from automated ECG measurements have not been explored for their predictive values in heart failure (HF). We investigated whether automated P-wave indices can predict adverse outcomes in HF.

Methods: This study included consecutive Chinese patients admitted to a single tertiary centre, presenting with HF but without prior AF, and with at least one baseline ECG, between 1 January 2010 and 31 December 2016, with last follow-up of 31 December 2019.

Results: A total of 2718 patients were included [median age: 77.4, interquartile range (IQR): (66.9–84.3) years; 47.9 males]. After a median follow-up of 4.8 years (IQR: 1.9–9.0 years), 1150 patients developed AF (8.8/year), 339 developed stroke (2.6/year), 563 developed cardiovascular mortality (4.3/year), and 1972 had all-cause mortality (15.1/year). Compared with 101–120 ms as a reference, maximum P-wave durations predicted new-onset AF at ≤90 ms [HR: 1.17(1.11, 1.50), P < 0.01], 131–140 ms [HR: 1.29(1.09, 1.54), P < 0.001], and ≥141 ms [HR: 1.52(1.32, 1.75), P < 0.001]. Similarly, they predicted cardiovascular mortality at ≤90 ms [HR: 1.50(1.08, 2.06), P < 0.001] or ≥141 ms [HR: 1.18(1.15, 1.45), P < 0.001], and all-cause mortality at ≤90 ms [HR: 1.26(1.04, 1.51), P < 0.001], 131–140 ms [HR: 1.15(1.01, 1.32), P < 0.01], and ≥141 ms [HR: 1.31(1.18, 1.46), P < 0.001]. These remained significant after adjusting for significant demographics, past co-morbidities, P-wave dispersion, and maximum P-wave amplitude.

Conclusions: Extreme values of maximum P-wave durations (≤90 ms and ≥141 ms) were significant predictors of new-onset AF, cardiovascular mortality, and all-cause mortality.

Item Type: Article
DOI/Identification number: 10.1002/ehf2.14230
Uncontrolled keywords: P-wave duration; Inter-atrial block; Heart failure; Stroke; Mortality
Subjects: R Medicine
Divisions: Divisions > Division of Natural Sciences > Kent and Medway Medical School
Funders: University of Kent (
SWORD Depositor: JISC Publications Router
Depositing User: JISC Publications Router
Date Deposited: 17 Jan 2023 11:51 UTC
Last Modified: 17 Apr 2023 15:18 UTC
Resource URI: (The current URI for this page, for reference purposes)

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