Key result
The presence of left atrial enlargement or fragmented QRS on baseline ECG did not predict the occurrence of new-onset atrial fibrillation in patients with severe chronic kidney disease.
Why the study?
The prevalence of ECG-diagnosed left atrial enlargement and fragmented QRS in severe chronic kidney disease was unknown, with limited data on predicting new-onset atrial fibrillation using these markers.
Does the presence of left atrial enlargement or fragmented QRS on ECG predict new-onset atrial fibrillation in patients with severe chronic kidney disease?
Cohort (n=165)
No
Does the presence of left atrial enlargement or fragmented QRS on ECG predict new-onset atrial fibrillation in patients with severe chronic kidney disease?
Answers are grounded in this paper and cite their sources.
In patients with severe chronic kidney disease not on dialysis, the prevalence of left atrial enlargement and fragmented QRS is very high, but neither ECG marker predicts the occurrence of new-onset atrial fibrillation.
Background The prevalence of left atrial enlargement (LAE) and fragmented QRS (fQRS) diagnosed using ECG criteria in patients with severe chronic kidney disease (CKD) is unknown. Furthermore, there is limited data on predicting new-onset atrial fibrillation (AF) with LAE or fQRS in this patient group. Methods We enrolled 165 consecutive non-dialysis patients with CKD stage 4–5 without prior AF diagnosis between 2013 and 2017 in a prospective follow-up cohort study. LAE was defined as total P-wave duration ≥120 ms in lead II ± > 1 biphasic P-waves in leads II, III or aVF; or duration of terminal negative portion of P-wave > 40 ms or depth of terminal negative portion of P-wave > 1 mm in lead V 1 from a baseline ECG, respectively. fQRS was defined as the presence of a notched R or S wave or the presence of ≥1 additional R waves (R’) or; in the presence of a wide QRS complex (> 120 ms), > 2 notches in R or S waves in two contiguous leads corresponding to a myocardial region, respectively. Results Mean age of the patients was 59 (SD 14) years, 56/165 (33.9%) were female and the mean estimated glomerular filtration rate was 12.8 ml/min/1.73m 2 . Altogether 29/165 (17.6%) patients were observed with new-onset AF within median follow-up of 3 [IQR 3, range 2–6] years. At baseline, 137/165 (83.0%) and 144/165 (87.3%) patients were observed with LAE and fQRS, respectively. Furthermore, LAE and fQRS co-existed in 121/165 (73.3%) patients. Neither findings were associated with the risk of new-onset AF within follow-up. Conclusion The prevalence of LAE and fQRS at baseline in this study on CKD stage 4–5 patients not on dialysis was very high. However, LAE or fQRS failed to predict occurrence of new-onset AF in these patients.
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Hellman et al. (2020) conducted a cohort in Severe chronic kidney disease (stage 4-5) (n=165). Left atrial enlargement (LAE) and fragmented QRS (fQRS) vs. Absence of LAE or fQRS was evaluated on Occurrence of new-onset atrial fibrillation (p=1.0). The presence of left atrial enlargement or fragmented QRS on baseline ECG did not predict the occurrence of new-onset atrial fibrillation in patients with severe chronic kidney disease.
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