PR interval, P-wave duration, and mortality: New insights, additional questions

AbstractBoth surgical and percutaneous closures of atrial septal defects have been successful in reversal of atrial dilatation. We compared the effects of surgical and percutaneous transvenous device closure of atrial septal defect on post-operative changes of P-wave duration, PR segment, and PR interval. Electrocardiographic data were prospectively collected from 30 patients following either surgical (n equal to 16) or percutaneous (n equal to 16) repair of atrial septal defects between 2004 and 2010. A cardiologist blinded to the closure technique performed the electrocardiographic analyses. P-wave duration (98.5 plus or minus 15.4 to 86.4 plus or minus 13.2 milliseconds, p-value less than 0.05) and PR interval (162.9 plus or minus 18.5 to 140.6 plus or minus 15.2 milliseconds, p-value less than 0.05) were reduced after percutaneous transvenous device closure. P-wave duration (104.5 plus or minus 24.7 versus 83.2 plus or minus 13.3 milliseconds, p-value less than 0.05) and PR interval (173.2 plus or minus 38.7 versus 144.3 plus or minus 32.0 milliseconds, p-value less than 0.05) were also reduced after surgical closure. PR segment in the percutaneous group was significantly reduced (63.4 plus or minus 14.5 to 52.1 plus or minus 10.8 milliseconds, p-value less than 0.05), but not in the surgical group (68.6 plus or minus 18.7 versus 61.1 plus or minus 24.7 milliseconds). However, the difference in PR segment changes between the two groups was not significant (−11.3 plus or minus 15.0 versus −7.6 plus or minus 20.5 milliseconds, p-value equal to 0.18). Our analysis demonstrates that the changes between the two groups were not different and that both closure techniques reduce P-wave duration, PR segment, and PR interval within 6 months.

Download Full-text

The association of the amounts of epicardial fat, P wave duration, and PR interval in electrocardiogram

Journal of Electrocardiology ◽

10.1016/j.jelectrocard.2018.04.009 ◽

2018 ◽

Vol 51 (4) ◽

pp. 645-651 ◽

Cited By ~ 5

Author(s):

Shih-Jie Jhuo ◽

Tsyh-Jyi Hsieh ◽

Wei-Hua Tang ◽

Wei-Chung Tsai ◽

Kun-Tai Lee ◽

...

Keyword(s):

P Wave ◽

Epicardial Fat ◽

Wave Duration ◽

P Wave Duration ◽

Pr Interval

Download Full-text

Time- and frequency-domain analysis of beat to beat P-wave duration, PR interval and RR interval can predict asystole as form of syncope during head-up tilt

Physiological Measurement ◽

10.1088/0967-3334/37/11/1910 ◽

2016 ◽

Vol 37 (11) ◽

pp. 1910-1924 ◽

Cited By ~ 1

Author(s):

Gianfranco Piccirillo ◽

Federica Moscucci ◽

Claudia Fiorucci ◽

Claudia Di Iorio ◽

Fabiola Mastropietri ◽

...

Keyword(s):

Frequency Domain ◽

Domain Analysis ◽

Frequency Domain Analysis ◽

P Wave ◽

Wave Duration ◽

Rr Interval ◽

P Wave Duration ◽

Pr Interval ◽

Head Up Tilt

Download Full-text

1348Impact of genetically determined differences in ECG parameters on risk of AF in c. 300,000 UK Biobank participants

European Heart Journal ◽

10.1093/eurheartj/ehz748.0048 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

P R Gajendragadkar ◽

A K Von Ende ◽

B Casadei ◽

J C Hopewell

Keyword(s):

Odds Ratio ◽

Qt Interval ◽

P Wave ◽

Sensitivity Analyses ◽

Uk Biobank ◽

Wave Duration ◽

P Wave Duration ◽

Pr Interval ◽

Genetically Determined ◽

The Impact

Abstract Background An abnormal electrical substrate has been associated with atrial cardiomyopathy, atrial fibrillation (AF), and other supraventricular tachycardias (SVT). However, many risk factors for AF influence ECG parameters, potentially confounding the association. As ECG intervals are highly heritable, using genetic scores as proxies limits confounding and the effects of reverse causation. Purpose To establish the nature of any causal relationship between ECG parameters and risk of AF using Mendelian randomisation (MR) techniques. Methods Genetic scores for P-wave duration, PR interval and QT interval were constructed from published genome-wide association studies and logistic regression models used to estimate their associations with AF using individual participant data in UK Biobank (UKB) (15,311 AF cases and 262,320 controls). Validation was performed using summary data from the AFGEN consortium (15,979 AF cases and 102,776 controls). Sensitivity analyses exploring the impact of potential pleiotropy were performed using conventional MR techniques (e.g. weighted median, MR-Egger etc). Results As expected, the genetic scores were strongly associated with their specified ECG parameters. Longer genetically determined P-wave and PR interval durations were associated with lower risks of AF. By contrast, a longer genetically determined QT interval was not associated with AF risk (Figure). To investigate the role of changes in electrical pathways affecting the ECG and AF risk, scores for each parameter were generated limited to genetic proxies associated with genes for known ion channels. Ion channel limited scores lowered risks of AF per 5ms increases in P-wave duration (odds ratio [OR]: 0.83; 95% confidence interval [CI]: 078–0.89, P=2×10–8) and PR interval (OR: 0.92; 95% CI: 0.90–0.95, P=4×10–10) with no change in AF risk with longer score for QT interval (OR: 0.99; 95% CI: 0.96–1.03, P=0.68). These effects were consistently replicated in the AFGEN dataset and multiple sensitivity analyses supported the conclusions. To test associations between the ECG genetic scores and a specific AF subtype, 3,843 participants with AF but without known coronary heart disease, heart failure, hypertension or diabetes and 273,788 controls were identified. Overall odds ratio estimates were similar to the primary outcomes for each of the ECG parameters investigated (Figure). To investigate the effects of altered electrical substrate on other related arrhythmias, 2,621 cases of SVT and 275,010 controls were identified. Longer genetic P-wave and PR intervals were associated with lower risks of SVT. The genetic QT interval was not associated with SVT risk (Figure). Figure 1 Conclusions Genetically determined ECG parameters associated with shorter atrial electrical conduction times increased risk of AF and SVT. These findings provide a novel mechanistic insight into understanding the underlying pathophysiology of AF and potential development of therapeutic strategies. Acknowledgement/Funding British Heart Foundation

Download Full-text

Effects of reproductive period duration and number of pregnancies on midlife ECG indices: a secondary analysis from the Women’s Health Initiative Clinical Trial

BMJ Open ◽

10.1136/bmjopen-2017-019129 ◽

2018 ◽

Vol 8 (8) ◽

pp. e019129 ◽

Cited By ~ 2

Author(s):

Nisha I Parikh ◽

Kristopher Kapphahn ◽

Haley Hedlin ◽

Jeffrey E Olgin ◽

Matthew A Allison ◽

...

Keyword(s):

Women's Health ◽

Reproductive Period ◽

P Wave ◽

Women's Health Initiative ◽

Live Births ◽

Wave Duration ◽

Health Initiative ◽

P Wave Duration ◽

Pr Interval ◽

The Women’S Health Initiative

ObjectivesPregnancy, menses and menopause are related to fluctuations in endogenous sex hormones in women, which cumulatively may alter cardiac electrical conduction. Therefore, we sought to study the association between number of pregnancies and reproductive period duration (RD, time from menarche to menopause) with ECG intervals in the Women’s Health Initiative Clinical Trials.DesignSecondary analysis of multicentre clinical trial.SettingUSA.Primary outcome measuresECGintervals: PR interval, P-wave duration, P-wave dispersion, QTc interval.Participantsn=40 687 women (mean age=62 years) participating in the Women’s Health Initiative Clinical Trials. 82.5% were white, 9.3% black, 4% Hispanic and 2.7% Asian.MethodsIn primary analysis, we employed multivariable linear regression models relating number of pregnancies and RD with millisecond changes in intervals from enrolment ECG. We studied effect modification by hormone therapy use.ResultsAmong participants, 5+ live births versus 0 prior pregnancies was associated with a 1.32 ms increase in PR interval (95% CI 0.25 to 2.38), with a graded association with longer QTc interval (ms) (none (prior pregnancy, no live births)=0.66 (–0.56 to 1.88), 1=0.15 (–0.71 to 1.02), 2–4=0.25 (–0.43 to 0.94) and 5+ live births=1.15 (0.33 to 1.98), p=0.008). RD was associated with longer PR interval and maximum P-wave duration (but not P-wave dispersion) among never users of hormone therapy: (PR (ms) per additional RD year: 0.10 (0.04 to 0.16); higher P-wave duration (ms): 0.09 (0.06 to 0.12)). For every year increase in reproductive period, QTc decreased by 0.04 ms (−0.07 to –0.01).ConclusionsAn increasing number of live births is related to increased and RD to decreased ventricular repolarisation time. Both grand multiparity and longer RD are related to increased atrial conduction time. Reproductive factors that alter midlife cardiac electrical conduction system remodelling in women may modestly influence cardiovascular disease risk in later life.Trial registration numberNCT00000611; Post-results.

Download Full-text

ECG markers of atrial abnormalities are not associated with new onset atrial fibrillation in patients with acute ST-segment elevation myocardial infarction

European Heart Journal ◽

10.1093/eurheartj/ehab724.1460 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

M Baturova ◽

M M Demidova ◽

J Carlson ◽

D Erlinge ◽

P G Platonov

Keyword(s):

Clinical Characteristics ◽

P Wave ◽

St Segment Elevation ◽

Wave Duration ◽

Segment Elevation Myocardial Infarction ◽

P Wave Duration ◽

St Segment ◽

Pr Interval ◽

Structural Abnormalities ◽

New Onset

Abstract Introduction New onset AF is a known complication in patients with acute ST-segment elevation myocardial infarction (STEMI). However, whether new-onset AF is linked to atrial structural abnormalities or has different underlying mechanisms is not fully clarified. Purpose We aimed to assess the association of P wave indices as ECG markers of atrial structural abnormalities with new-onset AF in STEMI patients undergoing primary percutaneous intervention (PCI). Methods Study sample comprised of 2277 consecutive patients with STEMI admitted to a tertiary care hospital for primary PCI from 2007 to 2010. SWEDEHEART registry was used as the source of information regarding clinical characteristics and events during index admission, including new-onset AF. The closest available ECGs prior to STEMI (median 448, interquartile rate 25–75% 112–1390 days before STEMI) were extracted from the regional electronic ECG databases and automatically processed using Glasgow algorithm. Patients with sinus rhythm ECGs were included in the current analysis (n=1481, mean age 68±12 years, 33% females). P-wave duration, PR interval, P-wave frontal axis and P terminal force in lead V1 (PTF-V1) were assessed. PTF-V1 >40 mm*ms was considered abnormal. Results Paroxysmal AF prior to STEMI was known in 77 patients (5.2%). Among patients without pre-existing AF (n=1404), new-onset AF during hospital admission was identified in 102 patients (6.9%). Patients with new-onset AF were older than those without AF history (74±9 vs 67±12 years, p<0.001), but did not differ in regard to other clinical characteristics. In univariate logistic regression analysis P wave duration as continuous variable, P wave duration >120 ms and PR interval were significantly associated with new onset AF (Table 1). However, after adjustment for age both, P wave duration >120 ms (odds ratio (OR) 1.20, 95% CI 0.77–1.89, p=0.418) and PR interval (OR 1.01, 95% CI 1.00–1.01, p=0.068), failed to demonstrate the significant association with new onset AF while age (OR 1.06, 95% CI 1.04–1.08, p<0.001) remained an independent risk factor for AF development. Conclusion In patients with acute STEMI new onset AF developed during hospital admission is common and strongly associated with age. P wave indices failed to demonstrate the significant association with new onset AF thus indicating that atrial structural abnormalities are unlikely the underlying cause of AF development in acute STEMI. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Scholarship grant from Swedish Institute. Table 1

Download Full-text

The Dose-Dependent Effects of Spironolactone on TGF-β1 Expression and the Vulnerability to Atrial Fibrillation in Spontaneously Hypertensive Rats

Cardiology Research and Practice ◽

10.1155/2021/9924381 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Mirong Tang ◽

Yan Chen ◽

Fuqing Sun ◽

Liangliang Yan

Keyword(s):

Atrial Fibrillation ◽

Cell Size ◽

Saline Solution ◽

Myocardial Cell ◽

P Wave ◽

Atrial Fibrosis ◽

Wave Duration ◽

P Wave Duration ◽

Pr Interval ◽

Tgf Β1

Objective. This study tends to assess the dose-dependent effects of spironolactone on TGF-β1 expression, atrial fibrosis, and the vulnerability to atrial fibrillation in spontaneously hypertensive rats (SHRs) and tries to clarify the association of atrial fibrosis with the vulnerability to atrial fibrillation. Methods. Forty 20-week-old male SHRs were randomly divided into 4 groups (10 rats per group): 3 spironolactone groups were lower-dose group (10 mg·kg−1·d−1, dissolved in 2 ml saline solution, group SL), medium-dose group (40 mg·kg−1·d−1, dissolved in 2 ml saline solution, group SM), higher-dose group (80 mg·kg−1·d−1, dissolved in 2 ml saline solution, group SH) and one hypertension group (2 ml saline solution for stomach gavage, group H). Ten matched homologous WKY rats were set as the control group (group C). After 7 weeks of gavage, a multiple electroconductive physiological recorder was used to detect atrial electrical parameters, including P-wave duration, PR interval, and atrial effective refractory period (AERP), the inducibility, and duration of atrial fibrillation. HE staining was used to determine myocardial cell size. Masson staining was used to detect the deposition of the interstitial collagen fibers in atrial muscle. The expression of TGF-β1 was detected by immunohistochemistry and western blot. Results. Compared with group C, the myocardial cell size, atrial fibrosis, TGF-β1 expression, P-wave duration, PR interval, AERP, inducibility, and duration of atrial fibrillation in group H were conspicuously increased ( p < 0.05); compared with group H, there was no significant difference in the myocardial cell size, atrial fibrosis, TGF-β1 expression, and electrophysiological indexes in group SH upon spironolactone intervention ( p > 0.05); compared with group H, the myocardial cell size, atrial fibrosis, the expression of TGF-β1, P-wave duration, PR interval, the inducibility, and duration of atrial fibrillation in the group SL and group SM were all decreased ( p < 0.05); compared with group SM, the effect in the group SL was more prominent ( p < 0.01). Conclusion. Hypertension can lead to cardiomyocyte hypertrophy, deposition of interstitial fibrosis in myocardial tissue, and an increase in the vulnerability to atrial fibrillation. Spironolactone showed a certain dose-dependent effect in SHRs. Lower-dose spironolactone was superior to higher-dose spironolactone in the aspect of reducing hypertensive atrial fibrosis and TGF-β1 expression, as well as preventing the occurrence of atrial fibrillation.

Download Full-text

The ECG Characteristics of Patients With Isolated Hypomagnesemia

Frontiers in Physiology ◽

10.3389/fphys.2020.617374 ◽

2021 ◽

Vol 11 ◽

Author(s):

Yiheng Yang ◽

Cheng Chen ◽

Penghong Duan ◽

Suman Thapaliya ◽

Lianjun Gao ◽

...

Keyword(s):

Serum Magnesium ◽

Final Analysis ◽

Wave Dispersion ◽

Normal Serum ◽

P Wave ◽

P Wave Dispersion ◽

Wave Duration ◽

P Wave Duration ◽

Pr Interval ◽

Qrs Duration

BackgroundElectrocardiographic (ECG) characteristics of patients with isolated hypomagnesemia are not well defined. We aimed to investigate these ECG characteristics in order to define clearly the features of isolated hypomagnesemia.HypothesisLower serum magnesium could affect ECG parameters after excluding potential confounders.MethodsThis retrospective study was of patients with low serum magnesium <0.65 mmol/L compared with the same patients after restoration to normal serum magnesium. Patients with hypokalemia, hypocalcemia and other electrolyte disturbances were excluded. ECG parameters manually determined and analyzed were P wave dispersion, PR interval, QRS duration, ST-T changes, T wave amplitude, T peak-to-end interval (Tpe), corrected Tpe (Tpec), QT, corrected QT (QTc), QT peak corrected (QTpc) and Tpe dispersion, Tpe/QT ratio.ResultsTwo-hundred-and-fourteen patients with isolated hypomagnesemia were identified with 50 of them (56.9 ± 13.6 years; 25 males) being eligible for final analysis from 270,997 patients presenting April 2011–October 2017. In the period of isolated hypomagnesemia, P wave duration was found prolonged (p ≤ 0.02); as was QTc (439 ± 27 vs. 433 ± 22, p = 0.01). Tpec (122 ± 24vs. 111 ± 22, p = 0.000) and Tpe/QT ratio (0.29 ± 0.05 vs. 0.27 ± 0.05, p = 0.000) were increased. QTpc decreased during hypomagnesemia (334 ± 28 vs. 342 ± 21, p = 0.02). However, no significant differences were found in PR interval, QRS duration (85 ± 12 ms vs. 86 ± 12 ms, p = 0.122) and ST-T segments between the patients and their own controls.ConclusionsIn patients with isolated hypomagnesemia, P wave duration, QTc, Tpec, and Tpe/QT ratio suggesting atrial depolarization and ventricular repolarization dispersion were significantly increased compared with normal magnesium levels in the same patients after restoration to normal levels.

Download Full-text

Assessment of the causal relevance of ECG parameters for risk of atrial fibrillation: A mendelian randomisation study

PLoS Medicine ◽

10.1371/journal.pmed.1003572 ◽

2021 ◽

Vol 18 (5) ◽

pp. e1003572

Author(s):

Parag Ravindra Gajendragadkar ◽

Adam Von Ende ◽

Maysson Ibrahim ◽

Elsa Valdes-Marquez ◽

Christian Fielder Camm ◽

...

Keyword(s):

Atrial Fibrillation ◽

Qt Interval ◽

P Wave ◽

Mendelian Randomisation ◽

Uk Biobank ◽

Causal Relevance ◽

Wave Duration ◽

P Wave Duration ◽

Atrial Size ◽

Pr Interval

Background Atrial electrical and structural remodelling in older individuals with cardiovascular risk factors has been associated with changes in surface electrocardiographic (ECG) parameters (e.g., prolongation of the PR interval) and higher risks of atrial fibrillation (AF). However, it has been difficult to establish whether altered ECG parameters are the cause or a consequence of the myocardial substrate leading to AF. This study aimed to examine the potential causal relevance of ECG parameters on risk of AF using mendelian randomisation (MR). Methods and findings Weighted genetic scores explaining lifelong differences in P-wave duration, PR interval, and QT interval were constructed, and associations between these ECG scores and risk of AF were estimated among 278,792 UK Biobank participants (mean age: 57 years at recruitment; 19,132 AF cases). The independent genetic variants contributing to each of the separate ECG scores, and their corresponding weights, were based on published genome-wide association studies. In UK Biobank, genetic scores representing a 5 ms longer P-wave duration or PR interval were significantly associated with lower risks of AF (odds ratio [OR] 0.91; 95% confidence interval [CI]: 0.87–0.96, P = 2 × 10−4 and OR 0.94; 95% CI: 0.93–0.96, P = 2 × 10−19, respectively), while longer QT interval was not significantly associated with AF. These effects were independently replicated among a further 17,931 AF cases from the AFGen Consortium. Investigation of potential mechanistic pathways showed that differences in ECG parameters associated with specific ion channel genes had effects on risk of AF consistent with the overall scores, while the overall scores were not associated with changes in left atrial size. Limitations of the study included the inherent assumptions of MR, restriction to individuals of European ancestry, and possible restriction of results to the normal ECG ranges represented in UK Biobank. Conclusions In UK Biobank, we observed evidence suggesting a causal relationship between lifelong differences in ECG parameters (particularly PR interval) that reflect longer atrial conduction times and a lower risk of AF. These findings, which appear to be independent of atrial size and concomitant cardiovascular comorbidity, support the relevance of varying mechanisms underpinning AF and indicate that more individualised treatment strategies warrant consideration.

Download Full-text