Document Detail

Abnormal P-wave morphology is a predictor of atrial fibrillation development and cardiac death in MADIT II patients.
MedLine Citation:
PMID:  20146784     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Several ECG-based approaches have been shown to add value when risk-stratifying patients with congestive heart failure, but little attention has been paid to the prognostic value of abnormal atrial depolarization in this context. The aim of this study was to noninvasively analyze the atrial depolarization phase to identify markers associated with increased risk of mortality, deterioration of heart failure, and development of atrial fibrillation (AF) in a high-risk population with advanced congestive heart failure and a history of acute myocardial infarction. METHODS: Patients included in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) with sinus rhythm at baseline were studied (n = 802). Unfiltered and band-pass filtered signal-averaged P waves were analyzed to determine orthogonal P-wave morphology (prespecified types 1, 2, and 3/atypical), P-wave duration, and RMS20. The association between P-wave parameters and data on the clinical course and cardiac events during a mean follow-up of 20 months was analyzed. RESULTS: P-wave duration was 139 + or - 23 ms and the RMS20 was 1.9 + or - 1.1 microV. None of these parameters was significantly associated with poor cardiac outcome or AF development. After adjustment for clinical covariates, abnormal P-wave morphology was found to be independently predictive of nonsudden cardiac death (HR 2.66; 95% CI 1.41-5.04, P = 0.0027) and AF development (HR 1.75; 95% CI 1.10-2.79, P = 0.019). CONCLUSION: Abnormalities in P-wave morphology recorded from orthogonal leads in surface ECG are independently predictive of increased risk of nonsudden cardiac death and AF development in MADIT II patients.
Fredrik Holmqvist; Pyotr G Platonov; Scott McNitt; Slava Polonsky; Jonas Carlson; Wojciech Zareba; Arthur J Moss;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc     Volume:  15     ISSN:  1542-474X     ISO Abbreviation:  Ann Noninvasive Electrocardiol     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-02-11     Completed Date:  2010-05-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9607443     Medline TA:  Ann Noninvasive Electrocardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  63-72     Citation Subset:  IM    
Department of Cardiology, Lund University Hospital, SE-221 85 Lund, Sweden.
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MeSH Terms
Atrial Fibrillation / complications,  diagnosis*
Defibrillators, Implantable*
Electrocardiography / methods*,  statistics & numerical data*
Follow-Up Studies
Heart Failure / complications*,  therapy
Middle Aged
Myocardial Infarction / complications*,  therapy
Myocardial Ischemia / complications
Predictive Value of Tests
Risk Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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