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Relation of Prolonged P-Wave Duration to Risk of Sudden Cardiac Death in the General Population (from the Atherosclerosis Risk in Communities Study).

TitleRelation of Prolonged P-Wave Duration to Risk of Sudden Cardiac Death in the General Population (from the Atherosclerosis Risk in Communities Study).
Publication TypeJournal Article
Year of Publication2017
AuthorsMaheshwari A, Norby FL, Soliman EZ, M Alraies C, Adabag S, O'Neal WT, Alonso A
Secondary AuthorsChen LYee
JournalAm J Cardiol
Volume119
Issue9
Pagination1302-1306
Date Published2017 05 01
ISSN1879-1913
KeywordsAfrican Americans, Atrial Fibrillation, Brugada Syndrome, Cardiac Conduction System Disease, Cause of Death, Cohort Studies, Coronary Disease, Death, Sudden, Cardiac, Electrocardiography, European Continental Ancestry Group, Female, Humans, Independent Living, Male, Middle Aged, Proportional Hazards Models, Prospective Studies, Risk Factors, Tachycardia, Ventricular, United States
Abstract

Prolonged P-wave duration, a marker of left atrial abnormality, is associated with myocardial fibrosis, atrial fibrillation, and all-cause death. It is not known if prolonged P-wave duration is associated with sudden cardiac death (SCD) in the general population. We aimed to evaluate whether prolonged P-wave duration is independently associated with SCD risk in the Atherosclerosis Risk in Communities Study, a community-based prospective cohort study. We included 15,321 participants in our analysis (age 54.2 ± 5.7 years, 55.2% women, 26.4% black). Prolonged P-wave duration was defined as maximum P-wave duration >120 ms and was determined from 12-lead electrocardiograms obtained during 4 exams (1987 to 1999). SCD was physician adjudicated and defined as a sudden, pulseless condition in a previously stable patient without evidence for noncardiac cause of death. We used Cox proportional hazard models to assess the association between prolonged P-wave duration and SCD, adjusting for cardiovascular risk factors and conditions including atrial fibrillation. During a mean follow-up of 12.5 years (1987 to 2001), 268 SCDs were identified. The multivariable hazard ratio (95% confidence interval) of prolonged P-wave duration for SCD was 1.70 (1.31 to 2.20). This association was attenuated but remained significant after updating covariates to the end of follow-up with a hazard ratio of 1.35 (1.04 to 1.76). In conclusion, prolonged P-wave duration is independently associated with an increased risk of SCD in the general population. This association is independent of atrial fibrillation and is only partially mediated by shared cardiovascular risk factors.

DOI10.1016/j.amjcard.2017.01.012
Alternate JournalAm J Cardiol
PubMed ID28267962
PubMed Central IDPMC5444665
Grant ListHHSN268201100012C / HL / NHLBI NIH HHS / United States
HHSN268201100010C / HL / NHLBI NIH HHS / United States
HHSN268201100008C / HL / NHLBI NIH HHS / United States
HHSN268201100007C / HL / NHLBI NIH HHS / United States
HHSN268201100011C / HL / NHLBI NIH HHS / United States
HHSN268201100006C / HL / NHLBI NIH HHS / United States
HHSN268201300024C / HL / NHLBI NIH HHS / United States
HHSN268201100009C / HL / NHLBI NIH HHS / United States
HHSN268201100005C / HL / NHLBI NIH HHS / United States
HHSN268200900020C / HL / NHLBI NIH HHS / United States