University of Oulu

Antti Eranti, Jonas Carlson, Tuomas Kenttä, Fredrik Holmqvist, Arttu Holkeri, M Anette Haukilahti, Tuomas Kerola, Aapo L Aro, Harri Rissanen, Kai Noponen, Tapio Seppänen, Paul Knekt, Markku Heliövaara, Heikki V Huikuri, M Juhani Junttila, Pyotr G Platonov, Orthogonal P-wave morphology, conventional P-wave indices, and the risk of atrial fibrillation in the general population using data from the Finnish Hospital Discharge Register, EP Europace, Volume 22, Issue 8, August 2020, Pages 1173–1181,

Orthogonal P-wave morphology, conventional P-wave indices, and the risk of atrial fibrillation in the general population using data from the Finnish Hospital Discharge Register

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Author: Eranti, Antti1; Carlson, Jonas2; Kenttä, Tuomas3;
Organizations: 1Heart Center , Central Hospital of North Karelia, Tikkamäentie 16, 80210 Joensuu, Finland
2Department of Cardiology , Lund University, Entrégatan 7, 22185 Lund, Sweden
3Research Unit of Internal Medicine , Medical Research Center, Oulu University Hospital and University of Oulu, Kajaanintie 50, 90220 Oulu, Finland
4Department of Cardiology , Center for Integrative Electrocardiography, Clinical Sciences at Lund University and Arrhythmia Clinic, Skåne University Hospital, Entrégatan 7, 22185 Lund, Sweden
5Heart and Lung Center , University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
6Department of Internal Medicine , Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850 Lahti, Finland
7Department of Public Health Solutions , Finnish Institute for Health and Welfare (THL), Mannerheimintie 166, 00271 Helsinki, Finland
8Center for Machine Vision and Signal Analysis , University of Oulu, Pentti Kaiteran katu 1, 90014 Oulu, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.8 MB)
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Language: English
Published: Oxford University Press, 2020
Publish Date: 2021-06-18


Aims: Identifying subjects at high and low risk of atrial fibrillation (AF) is of interest. This study aims to assess the risk of AF associated with electrocardiographic (ECG) markers linked to atrial fibrosis: P-wave prolongation, 3rd-degree interatrial block, P-terminal force in lead V1, and orthogonal P-wave morphology.

Methods and results: P-wave parameters were assessed in a representative Finnish population sample aged ≥30 years (n = 7217, 46.0% male, mean age 51.4 years). Subjects (n = 5489) with a readable ECG including the orthogonal leads, sinus rhythm, and a predefined orthogonal P-wave morphology type [positive in leads X and Y and either negative (Type 1) or ± biphasic (Type 2) in lead Z; Type 3 defined as positive in lead X and ± biphasic in lead Y], were followed 10 years from the baseline examinations (performed 1978–80). Subjects discharged with AF diagnosis after any-cause hospitalization (n = 124) were defined as having developed AF. Third-degree interatrial block was defined as P-wave ≥120 ms and the presence of ≥2 ± biphasic P waves in the inferior leads. Hazard ratios (HRs) and confidence intervals (CIs) were assessed with Cox models. Third-degree interatrial block (n = 103, HR 3.18, 95% CI 1.66–6.13; P = 0.001) and Type 3 morphology (n = 216, HR 3.01, 95% CI 1.66–5.45; P < 0.001) were independently associated with the risk of hospitalization with AF. Subjects with P-wave <110 ms and Type 1 morphology (n = 2074) were at low risk (HR 0.46, 95% CI 0.26–0.83; P = 0.006), compared to the rest of the subjects.

Conclusion: P-wave parameters associate with the risk of hospitalization with AF.

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Series: EP-Europace. The European Journal of Pacing, Arrhythmias and Cardiac Electrophysiology of the European Heart Rhythm Association of the European Society of Cardiology
ISSN: 1099-5129
ISSN-E: 1532-2092
ISSN-L: 1099-5129
Volume: 22
Issue: 8
Pages: 1173 - 1181
DOI: 10.1093/europace/euaa118
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: This work was supported by Aarne Koskelo Foundation (A.H., T.V.K.); Academy of Finland 6Genesis Flagship (grant 318927) (T.S.); ALF funding within the Swedish Healthcare System (P.G.P.); Emil Aaltonen’s Foundation (A.E.); Finnish Foundation of Cardiovascular Research (H.V.H., M.J.J.); Finnish Medical Foundation (A.E., A.H., A.L.A.); Onni and Hilja Tuovinen’s Foundation (A.E.); Paavo Ilmari Ahvenainen Foundation (A.H.); Paavo Nurmi’s Foundation (A.E.); Paulo Foundation (T.V.K.); Sigrid Juselius Foundation (A.H., A.L.A., H.V.H., M.J.J.); Tauno Tönning Foundation (K.N.); The Orion Research Foundation (A.E., T.V.K.); The Swedish Heart-Lung-Foundation (P.G.P.).
Academy of Finland Grant Number: 318927
Detailed Information: 318927 (Academy of Finland Funding decision)
Copyright information: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. This article has been accepted for publication in Europace Published by Oxford University Press.