P-wave durations from automated electrocardiogram analysis to predict atrial fibrillation and mortality in heart failure

Jiandong Zhou, Andrew Li, Martin Tan, Matthew Chung Yan Lam, Lok Tin Hung, Ronald Wing Hei Siu, Sharen Lee, Ishan Lakhani, Jeffrey Shi Kai Chan, Khalid Bin Waleed, Tong Liu, Kamalan Jeevaratnam, Qingpeng Zhang, Gary Tse

Research output: Contribution to journalArticlepeer-review


Background: P-wave indices have been used to predict incident atrial fibrillation (AF), stroke, and mortality. However, such indices derived from automated ECG measurements have not been explored for their predictive values in heart failure (HF). We investigated whether automated P-wave indices can predict adverse outcomes in HF. Methods: This study included consecutive Chinese patients admitted to a single tertiary centre, presenting with HF but without prior AF, and with at least one baseline ECG, between 1 January 2010 and 31 December 2016, with last follow-up of 31 December 2019. Results: A total of 2718 patients were included [median age: 77.4, interquartile range (IQR): (66.9–84.3) years; 47.9 males]. After a median follow-up of 4.8 years (IQR: 1.9–9.0 years), 1150 patients developed AF (8.8/year), 339 developed stroke (2.6/year), 563 developed cardiovascular mortality (4.3/year), and 1972 had all-cause mortality (15.1/year). Compared with 101–120 ms as a reference, maximum P-wave durations predicted new-onset AF at ≤90 ms [HR: 1.17(1.11, 1.50), P < 0.01], 131–140 ms [HR: 1.29(1.09, 1.54), P < 0.001], and ≥141 ms [HR: 1.52(1.32, 1.75), P < 0.001]. Similarly, they predicted cardiovascular mortality at ≤90 ms [HR: 1.50(1.08, 2.06), P < 0.001] or ≥141 ms [HR: 1.18(1.15, 1.45), P < 0.001], and all-cause mortality at ≤90 ms [HR: 1.26(1.04, 1.51), P < 0.001], 131–140 ms [HR: 1.15(1.01, 1.32), P < 0.01], and ≥141 ms [HR: 1.31(1.18, 1.46), P < 0.001]. These remained significant after adjusting for significant demographics, past co-morbidities, P-wave dispersion, and maximum P-wave amplitude. Conclusions: Extreme values of maximum P-wave durations (≤90 ms and ≥141 ms) were significant predictors of new-onset AF, cardiovascular mortality, and all-cause mortality.

Original languageEnglish
Pages (from-to)872-883
Number of pages12
JournalESC Heart Failure
Issue number2
Publication statusPublished - Apr 2023


  • Heart failure
  • Inter-atrial block
  • Mortality
  • P-wave duration
  • Stroke


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