Key result
P-wave duration ≥ 100 ms in aVR linked to ~3.7-fold higher risk of AF in hypertension.
Why the study?
Does prolonged P-wave duration in lead aVR predict the presence of atrial fibrillation in patients with systemic hypertension?
Case-Control (n=88)
Blinded outcome assessment (investigators blinded to clinical info)
No
Does prolonged P-wave duration in lead aVR predict the presence of atrial fibrillation in patients with systemic hypertension?
Relative Risk: 3.7 (95% CI 1.3–10.3)
p-value: p=0.02
Measuring P-wave duration in ECG lead aVR is a simple, non-invasive method that can help identify hypertensive patients at elevated risk for atrial fibrillation.
May flag higher AF risk in hypertension via aVR measurement; leaves open prospective validation before adoption.
BACKGROUND: Hypertension entails atrial remodeling that affect P-wave (PW) duration on electrocardiogram (ECG). PW indices (e.g., variance, dispersion, and terminal force) are associated with a higher risk for atrial fibrillation (AF), but their calculation requires multiple measurements of PW duration, limiting their use in clinical practice. We evaluated whether PW duration in specific ECG leads may identify patients with increased susceptibility to AF in a population of hypertensive patients. METHODS: In a case-control study, AF and control subjects were matched for age, sex, and left atrial (LA) dimensions. PW duration was measured from digitally stored ECGs. Logistic regression was used to assess the association of PW duration and indices with AF. RESULTS: We enrolled 44 hypertensive AF patients (16 paroxysmal and 28 persistent) and 44 hypertensive controls. AF and control subjects were matched for sex (males, n = 27), age (67 ± 8 years), LA diameter (40 ± 5 mm), and were comparable for left ventricular mass (45 ± 11 g/m(2.7) vs 48 ± 12 g/m(2.7) , P = 0.19), ejection fraction (58 ± 7% in both groups), and prevalence of mild valvular heart disease (7% vs 5%; P = 0.64). PW duration in lead aVR was significantly higher in AF patients as compared with controls (115 ± 18 ms vs 101 ± 14 ms; P < 0.0001) and was the best independent predictor of AF in multivariable logistic regression (PW ≥ 100 ms: RR = 3.7; 95% CI: 1.3-10.3; P = 0.02). CONCLUSIONS: Simple measurement of PW duration in lead aVR allows effective identification of AF patients in a population of hypertensives. Confirmation of this finding in a larger population would provide a simple and effective risk marker of AF in hypertensive patients.
No takes yet. Share an insight, caveat, or question.
Francia et al. (2014) conducted a case-control in Hypertension and Atrial Fibrillation (n=88). P-wave duration ≥ 100 ms in ECG lead aVR vs. P-wave duration < 100 ms in ECG lead aVR was evaluated on Presence of atrial fibrillation (RR 3.7, 95% CI 1.3-10.3, p=0.02). P-wave duration ≥ 100 ms in lead aVR independently predicted the presence of atrial fibrillation in hypertensive patients (RR 3.7, 95% CI 1.3-10.3, p=0.02).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: