PR-Interval Components and Atrial Fibrillation Risk (From the Atherosclerosis Risk In Communities Study)

• Published in: The American journal of cardiology 2017-02, Vol.119 (3), p.466-472
• Main Authors: Smith, Justin W., MD, O’Neal, Wesley T., MD, MPH, Shoemaker, M. Benjamin, MD, MSCI, Chen, Lin Y., MD, MS, Alonso, Alvaro, MD, PhD, Whalen, S. Patrick, MD, Soliman, Elsayed Z., MD, MSc, MS
• Format: Article
• Language: English
• Subjects: African Americans - statistics & numerical data; Age; Atherosclerosis; Atrial Fibrillation - epidemiology; Brugada Syndrome - epidemiology; Brugada Syndrome - physiopathology; Cardiac arrhythmia; Cardiac Conduction System Disease; Cardiovascular; Cardiovascular disease; Confidence intervals; Diabetes; Electrocardiography; Epidemiology; Female; Heart attacks; Heart failure; Hospitals; Humans; Independent Living; Male; Middle Aged; Proportional Hazards Models; Risk Factors; United States - epidemiology; Whites - statistics & numerical data
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2016.10.016

Abstract Reports on the association between the PR-interval and atrial fibrillation (AF) are conflicting. We hypothesized that inconsistencies stem from that fact that the PR-interval is not a single electrocardiographic (ECG) phenotype, and it is more likely to represent a composite of several distinct components. We examined the association of the PR-interval and its components (P-wave onset to P-wave peak duration, P-wave peak to P-wave end duration, and PR-segment) with incident AF in 14,924 participants (mean age=54±5.8 years; 26% black; 55% female) from the Atherosclerosis Risk In Communities study. The PR-interval and its components were automatically measured at baseline (1987-1989) from standard 12-lead ECGs. PR-interval >200 ms was considered prolonged and values >95th percentile defined abnormal PR-interval components. AF was ascertained during follow-up through December 31, 2010. Over a median follow-up of 21.2 years, 1,985 (13%) participants developed AF. Prolonged PR-interval was associated with an increased risk of AF (HR=1.19, 95% CI=1.02, 1.40). However, PR-interval components showed varying levels of associations with AF (P-wave onset to P-wave peak duration: HR=1.57, 95%CI=1.31, 1.88; P-wave peak to P-wave end duration: HR=1.20, 95%CI=0.99, 1.46; and PR-segment: HR=1.05, 95%CI=0.85, 1.29). Additionally, the components of the PR-interval had weak to moderate correlation with each other (correlation r ranged from -0.44 to 0.06). In conclusion, our findings suggest the PR-interval represents a composite of distinct components that are not uniformly associated with AF. Without considering the contribution of each component, inconsistent associations between the PR-interval and AF are inevitable.