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ECG Features Associated With Adverse Cardiovascular Outcomes in Patients With Atrial Fibrillation: A Combined AFFIRM and AF‐CHF Analysis
Author(s) -
ANDRADE JASON G.,
ROY DENIS,
WYSE D. GEORGE,
DORIAN PAUL,
TALAJIC MARIO,
LEDUC HUGUES,
CADRINTOURIGNY JULIA,
SHOHOUDI AZADEH,
MACLE LAURENT,
THIBAULT BERNARD,
GUERRA PETER G.,
RIVARD LÉNA,
DUBUC MARC,
KHAIRY PAUL
Publication year - 2016
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.12934
Subject(s) - medicine , atrial fibrillation , hazard ratio , cardiology , sinus rhythm , confidence interval , qrs complex , proportional hazards model , heart failure
ECG and Cardiovascular Outcomes in AF Background The association between standard parameters from a simple 12‐lead ECG (i.e., QRS duration and PR, JT, and QT intervals) and adverse cardiovascular outcomes (cardiovascular mortality, all‐cause mortality, arrhythmic mortality, and hospitalizations) in patients with a history of atrial fibrillation (AF) has not been previously studied. Methods and Results A pooled analysis of patient‐level data was conducted on 5,436 patients, age 68.2 ± 8.3 years, 34.8% female, with a history of non‐permanent AF randomized in AFFIRM and AF‐CHF trials. The predictive value of ECG parameters was assessed in AF and sinus rhythm in multivariate Cox regression models. During a follow‐up of 40.8 ± 16.3 months, QRS duration >120 milliseconds was independently associated with all‐cause mortality (hazard ratio [HR] 1.46, 95% confidence interval [CI; 1.21–1.76] in AF, P < 0.001), cardiovascular mortality (HR 1.75, 95% CI (1.15–2.65) in sinus rhythm, P = 0.009; HR 1.56, 95% CI [1.27–1.93] in AF, P < 0.001), arrhythmic mortality (HR 1.90, 95% CI [1.09–3.32] in sinus, P = 0.024; HR 1.84, 95% CI [1.35–2.51] in AF, P < 0.001), any hospitalization (HR 1.15, 95% CI [1.02–1.29] in AF, P = 0.027), and cardiovascular hospitalization (HR 1.21, 95% CI [1.06–1.37] in AF; P = 0.004). Increased PR interval (>200 milliseconds) was independently associated with cardiovascular (HR 1.56, 95% CI [1.11–2.21], P = 0.010) and arrhythmic (HR 1.91, 95% CI [1.14–3.18], P = 0.004) mortality. The JT and QTc intervals were not predictive of mortality. Conclusions Simple parameters from standard ECGs are significantly and independently associated with adverse cardiovascular outcomes in patients with a history of AF.