Amplified P-wave duration predicts incident atrial fibrillation in the general population: Results from the Hamburg City Health Study

Background.Clinical risk factors identify subjects at risk of incident atrial fibrillation (AF) with only mediocre accuracy.Amplified P-wave duration (PWD) is a novel electrocardiographic marker for conduction delay in atrial cardiomyopathy, which in turn is associated with AF.Objective.The aim of this study is to assess whether amplified PWD can predict incident AF in the general population.Methods.Amplified PWD was assessed manually on a signal-modified electrocardiogram in 2,134 participants from the population-based Hamburg City Health Study.Incident AF during 5-year follow-up was defined as primary endpoint.Multivariable Cox regression models were constructed including significant clinical risk factors, ECG parameters and transthoracic echocardiography (TTE) parameters and the predictive power for the primary endpoint was evaluated.Results.Over a median follow-up of 5.5 years, 102 participants (4.8%) developed incident AF.The upper tertile of amplified P-wave duration was the only significant ECG-derived predictor for incident AF (Hazard Ratio [HR]: 2.02; p=.010) in the multivariable ECG-based model, alongside age (HR: 1.07; p=.013) and body mass index (HR: 1.08; p=.003), after adjustment for significant clinical risk factors (C-index: 0.764).A comprehensive combined ECG/TTE model achieved a C-index of 0.770, with age (HR: 1.07; p=.020) and left atrial volume (HR: 1.02; p=.020) remaining significant predictors. Conclusion.Amplified PWD as novel ECG-based marker predicts incident AF in a populationbased cohort and may provide a pragmatic ECG-derived marker of atrial cardiomyopathy for risk assessment beyond conventional risk stratification.