Electrocardiographic left ventricular hypertrophy predicts atrial fibrillation independent of left ventricular mass

Background Although left ventricular hypertrophy ( LVH ) detected by electrocardiography ( ECG ‐ LVH ) and echocardiography (echo‐ LVH ) independently predict cardiovascular disease events, it is unclear if ECG ‐ LVH and echo‐ LVH independently predict atrial fibrillation ( AF ). Methods This analysis included 4,904 participants (40% male; 85% white) from the Cardiovascular Health Study who were free of baseline AF and major intraventricular conduction delays. ECG ‐ LVH was defined by Minnesota Code Classification from baseline ECG data. Echo‐ LVH was defined by sex‐specific left ventricular mass values >95th sex‐specific percentiles. Incident AF events were identified during the annual study ECG s and from hospitalization discharge data. Cox regression was used to compute hazard ratios ( HR ) and 95% confidence intervals ( CI ) for the association of ECG ‐ LVH and echo‐ LVH with incident AF , separately. Results ECG ‐ LVH was detected in 224 (4.6%) participants and echo‐ LVH was present in 231 (4.7%) participants. Over a median follow‐up of 11.9 years, a total of 1,430 AF events were detected. In a multivariable Cox model adjusted for age, sex, race, education, income, smoking, systolic blood pressure, diabetes, body mass index, total cholesterol, high‐density lipoprotein cholesterol, aspirin, antihypertensive medications, and cardiovascular disease, ECG ‐ LVH ( HR  = 1.50; 95% CI  = 1.18, 1.90) and echo‐ LVH ( HR  = 1.39; 95% CI  = 1.09, 1.78) were independently associated with AF . When ECG ‐ LVH ( HR  = 1.47, 95% CI  = 1.16, 1.87) and echo‐ LVH ( HR  = 1.36, 1.07, 1.75) were included in the same model, both were predictive of incident AF . Conclusion The association of ECG ‐ LVH with AF is not dependent on left ventricular mass detected by echocardiography, suggesting that abnormalities in cardiac electrophysiology provide a distinct profile in the prediction of AF .