Amplified P-wave duration predicts incident atrial fibrillation in the general population: Results from the Hamburg City Health Study.

BACKGROUND

Clinical risk factors identify subjects at risk of incident atrial fibrillation (AF) with only mediocre accuracy. Amplified P-wave duration (PWD) is a novel electrocardiographic (ECG) marker for conduction delay in atrial cardiomyopathy, which in turn is associated with AF.

OBJECTIVE

This study aimed to assess whether amplified PWD can predict incident AF in the general population.

METHODS

Amplified PWD was assessed manually on a signal-modified ECG in 2134 participants from the population-based Hamburg City Health Study. Incident AF during the 5-year follow-up was defined as the primary end point. Multivariable Cox regression models were constructed including significant clinical risk factors, ECG parameters, and transthoracic echocardiography parameters, and the predictive power for the primary end point was evaluated.

RESULTS

Over a median follow-up of 5.5 years, 102 participants (4.8%) developed incident AF. The upper tertile of amplified PWD was the only significant ECG-derived predictor for incident AF (hazard ratio [HR] 2.02; P = .010) in the multivariable ECG-based model, alongside age (HR 1.07; P = .013) and body mass index (HR 1.08; P = .003), after adjustment for significant clinical risk factors (concordance index 0.764). A comprehensive combined ECG/transthoracic echocardiography model achieved a concordance index of 0.770, with age (HR 1.07; P = .020) and left atrial volume (HR 1.02; P = .020) remaining significant predictors.

CONCLUSION

Amplified PWD as a novel ECG-based marker predicts incident AF in a population-based cohort and may provide a pragmatic ECG-derived marker of atrial cardiomyopathy for risk assessment beyond conventional risk stratification.

CLINICAL TRIAL REGISTRATION: NCT03934957 (https://www.clinicaltrials.gov).