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Am J Cardiol. 2016 Sep 1;118(5):714-9. doi: 10.1016/j.amjcard.2016.06.008. Epub 2016 Jun 14.

Electrocardiographic Predictors of Incident Atrial Fibrillation.

Author information

1
Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California.
2
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
3
Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon.
4
Department of Medicine, Stanford University School of Medicine, Stanford, California.
5
Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri.
6
Division of Public Health Sciences, Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina.
7
Cardiovascular Health Research Unit, Department of Epidemiology, University of Washington, Seattle, Washington.
8
Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California. Electronic address: marcusg@medicine.ucsf.edu.

Abstract

Atrial fibrillation (AF) is likely secondary to multiple different pathophysiological mechanisms that are increasingly but incompletely understood. Motivated by the hypothesis that 3 previously described electrocardiographic predictors of AF identify distinct AF mechanisms, we sought to determine if these electrocardiographic findings independently predict incident disease. Among Cardiovascular Health Study participants without prevalent AF, we determined whether left anterior fascicular block (LAFB), a prolonged QTC, and atrial premature complexes (APCs) each predicted AF after adjusting for each other. We then calculated the attributable risk in the exposed for each electrocardiographic marker. LAFB and QTC intervals were assessed on baseline 12-lead electrocardiogram (n = 4,696). APC count was determined using 24-hour Holter recordings obtained in a random subsample (n = 1,234). After adjusting for potential confounders and each electrocardiographic marker, LAFB (hazard ratio [HR] 2.1, 95% confidence interval [CI] 1.1 to 3.9, p = 0.023), a prolonged QTC (HR 2.5, 95% CI 1.4 to 4.3, p = 0.002), and every doubling of APC count (HR 1.2, 95% CI 1.1 to 1.3, p <0.001) each remained independently predictive of incident AF. The attributable risk of AF in the exposed was 35% (95% CI 13% to 52%) for LAFB, 25% (95% CI 0.6% to 44%) for a prolonged QTC, and 34% (95% CI 26% to 42%) for APCs. In conclusion, in a community-based cohort, 3 previously established electrocardiogram-derived AF predictors were each independently associated with incident AF, suggesting that they may represent distinct mechanisms underlying the disease.

PMID:
27448684
PMCID:
PMC5503745
DOI:
10.1016/j.amjcard.2016.06.008
[Indexed for MEDLINE]
Free PMC Article

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