What is the clinical evidence from this study?

Study design: Cohort. Population: P pulmonale (n=591). Intervention: PQ interval >150 ms vs. PQ interval ≤150 ms. Primary outcome: Development of atrial fibrillation (HR 6.89, 95% CI 2.39-29.15, p=<0.0001).

November 26, 2013Circulation Journal23 citationsOpen Access

P Pulmonale and the Development of Atrial Fibrillation

Q: What are the key findings of this study?

In patients with P pulmonale, a PQ interval greater than 150 ms was independently associated with a significantly increased risk of developing atrial fibrillation (HR 6.89).

HHHideki Hayashi AMAkashi Miyamoto TKTamiro Kawaguchi

Key Result

In patients with P pulmonale, a PQ interval greater than 150 ms was independently associated with a significantly increased risk of developing atrial fibrillation (HR 6.89).

Study Design

Type

Cohort (n=591)

Multicenter

Structured PICO

Population

591 patients aged 15 years and older with P pulmonale on resting 12-lead ECG, followed for a mean of 46.7 months to assess the development of atrial fibrillation.

Outcome

Development of atrial fibrillationhard clinical

In patients with P pulmonale, a prolonged PQ interval (>150ms) is a strong independent predictor for the development of atrial fibrillation.

Main Result

Hazard Ratio: 6.89 (95% CI 2.39–29.15)

p-value: p=<0.0001

Limitations

Reasons for undergoing ECG were not documented, as tests were ordered according to physician discretion
Intermittent or asymptomatic nature of AF may lead to underestimation of AF development
Clinical information such as echocardiographic markers was not included in the analysis
Clinical types of AF were not classified, meaning the severity of AF was not considered
Time interval between ECGs was not constant, which might have caused some episodes of AF incidence to be missed
Did not analyze the prognostic value of P pulmonale depending on the type of AF (paroxysmal, persistent, or permanent)

Abstract

BACKGROUND: P wave ≥0.25mV in inferior leads (P pulmonale) occurs in chronic lung diseases that underlie atrial fibrillation (AF). The purpose of this study was to elucidate the prognostic value of P pulmonale for development of AF. METHODS AND RESULTS: Digital analysis of 12-lead electrocardiogram (ECG) was conducted to enroll patients with P pulmonale from among a database containing 308,391 ECGs. In a total of 591 patients (382 men; 56.4±14.8 years) with P pulmonale (follow-up, 46.7±65.6 months), AF occurred in 61 patients (AF group), but did not occur in 530 patients (non-AF group). Male gender was significantly more prevalent in the AF group than in the non-AF group (80.3% vs. 62.8%, P=0.0047). P-wave duration and PQ interval were significantly longer in the AF group than in the non-AF group (115.4±17.2ms vs. 107.0±17.2ms, P=0.0003 and 166.3±23.9ms vs. 153.2±25.4ms, P=0.0001, respectively). In the total patient group, multivariate Cox proportional-hazards analysis confirmed that male gender (hazard ratio HR, 2.24; 95% confidence interval CI: 1.02-5.49; P=0.045), PQ interval >150ms (HR, 6.89; 95% CI: 2.39-29.15; P150ms (HR, 9.26; 95% CI: 1.75-170.65; P=0.0055) was independently and significantly associated with AF development. CONCLUSIONS: PQ interval is the strongest stratifier for AF development in P pulmonale.

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