Electrocardiographic intervals associated with incident atrial fibrillation: Dissecting the QT interval

Jason D. Roberts, Elsayed Z. Soliman, Alvaro Alonso, Eric Vittinghoff, Lin Y. Chen, Laura Loehr, Gregory M. Marcus

Research output: Contribution to journalArticle

Abstract

Background Prolongation of the QT interval has been associated with an increased risk of developing atrial fibrillation (AF), but the responsible mechanism remains unknown. Objectives The aims of this study were to subdivide the QT interval into its components and identify the resultant electrocardiographic interval(s) responsible for the association with AF. Methods Predefined QT-interval components were assessed for association with incident AF in the Atherosclerosis Risk in Communities study using Cox proportional hazards models. Hazard ratios (HRs) were calculated per 1-SD increase in each component. Among QT-interval components exhibiting significant associations, additional analyses evaluating long extremes, defined as greater than the 95th percentile, were performed. Results Of the 14,625 individuals, 1505 (10.3%) were diagnosed with incident AF during a mean follow-up period of 17.6 years. After multivariable adjustment, QT-interval components involved in repolarization, but not depolarization, exhibited significant associations with incident AF, including a longer ST segment (HR 1.27; 95% confidence interval [CI] 1.14–1.41; P <.001) and a prolonged T-wave onset to T-wave peak (T-onset to T-peak) (HR 1.13; 95% CI 1.07–1.20; P <.001). Marked prolongation of the ST segment (HR 1.31; 95% CI 1.04–1.64; P =.022) and T-onset to T-peak (HR 1.36; 95% CI 1.09–1.69; P =.006) was also associated with an increased risk of incident AF. Conclusion The association between a prolonged QT interval and incident AF is primarily explained by components involved in ventricular repolarization: prolongation of the ST segment and T-onset to T-peak. These observations suggest that prolongation of phases 2 and 3 of the cardiac action potential drives the association between the QT interval and AF risk.

LanguageEnglish (US)
Pages654-660
Number of pages7
JournalHeart Rhythm
Volume14
Issue number5
DOIs
StatePublished - May 1 2017

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Atrial Fibrillation
Confidence Intervals
Proportional Hazards Models
Action Potentials
Atherosclerosis

Keywords

  • Arrhythmia
  • Atrial fibrillation
  • Electrocardiography
  • Epidemiology
  • QT interval

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Roberts, J. D., Soliman, E. Z., Alonso, A., Vittinghoff, E., Chen, L. Y., Loehr, L., & Marcus, G. M. (2017). Electrocardiographic intervals associated with incident atrial fibrillation: Dissecting the QT interval. Heart Rhythm, 14(5), 654-660. DOI: 10.1016/j.hrthm.2017.02.005

Electrocardiographic intervals associated with incident atrial fibrillation : Dissecting the QT interval. / Roberts, Jason D.; Soliman, Elsayed Z.; Alonso, Alvaro; Vittinghoff, Eric; Chen, Lin Y.; Loehr, Laura; Marcus, Gregory M.

In: Heart Rhythm, Vol. 14, No. 5, 01.05.2017, p. 654-660.

Research output: Contribution to journalArticle

Roberts, JD, Soliman, EZ, Alonso, A, Vittinghoff, E, Chen, LY, Loehr, L & Marcus, GM 2017, 'Electrocardiographic intervals associated with incident atrial fibrillation: Dissecting the QT interval' Heart Rhythm, vol 14, no. 5, pp. 654-660. DOI: 10.1016/j.hrthm.2017.02.005
Roberts JD, Soliman EZ, Alonso A, Vittinghoff E, Chen LY, Loehr L et al. Electrocardiographic intervals associated with incident atrial fibrillation: Dissecting the QT interval. Heart Rhythm. 2017 May 1;14(5):654-660. Available from, DOI: 10.1016/j.hrthm.2017.02.005
Roberts, Jason D. ; Soliman, Elsayed Z. ; Alonso, Alvaro ; Vittinghoff, Eric ; Chen, Lin Y. ; Loehr, Laura ; Marcus, Gregory M./ Electrocardiographic intervals associated with incident atrial fibrillation : Dissecting the QT interval. In: Heart Rhythm. 2017 ; Vol. 14, No. 5. pp. 654-660
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abstract = "Background Prolongation of the QT interval has been associated with an increased risk of developing atrial fibrillation (AF), but the responsible mechanism remains unknown. Objectives The aims of this study were to subdivide the QT interval into its components and identify the resultant electrocardiographic interval(s) responsible for the association with AF. Methods Predefined QT-interval components were assessed for association with incident AF in the Atherosclerosis Risk in Communities study using Cox proportional hazards models. Hazard ratios (HRs) were calculated per 1-SD increase in each component. Among QT-interval components exhibiting significant associations, additional analyses evaluating long extremes, defined as greater than the 95th percentile, were performed. Results Of the 14,625 individuals, 1505 (10.3\{%}) were diagnosed with incident AF during a mean follow-up period of 17.6 years. After multivariable adjustment, QT-interval components involved in repolarization, but not depolarization, exhibited significant associations with incident AF, including a longer ST segment (HR 1.27; 95\{%} confidence interval [CI] 1.14–1.41; P <.001) and a prolonged T-wave onset to T-wave peak (T-onset to T-peak) (HR 1.13; 95\{%} CI 1.07–1.20; P <.001). Marked prolongation of the ST segment (HR 1.31; 95\{%} CI 1.04–1.64; P =.022) and T-onset to T-peak (HR 1.36; 95\{%} CI 1.09–1.69; P =.006) was also associated with an increased risk of incident AF. Conclusion The association between a prolonged QT interval and incident AF is primarily explained by components involved in ventricular repolarization: prolongation of the ST segment and T-onset to T-peak. These observations suggest that prolongation of phases 2 and 3 of the cardiac action potential drives the association between the QT interval and AF risk.",
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N2 - Background Prolongation of the QT interval has been associated with an increased risk of developing atrial fibrillation (AF), but the responsible mechanism remains unknown. Objectives The aims of this study were to subdivide the QT interval into its components and identify the resultant electrocardiographic interval(s) responsible for the association with AF. Methods Predefined QT-interval components were assessed for association with incident AF in the Atherosclerosis Risk in Communities study using Cox proportional hazards models. Hazard ratios (HRs) were calculated per 1-SD increase in each component. Among QT-interval components exhibiting significant associations, additional analyses evaluating long extremes, defined as greater than the 95th percentile, were performed. Results Of the 14,625 individuals, 1505 (10.3%) were diagnosed with incident AF during a mean follow-up period of 17.6 years. After multivariable adjustment, QT-interval components involved in repolarization, but not depolarization, exhibited significant associations with incident AF, including a longer ST segment (HR 1.27; 95% confidence interval [CI] 1.14–1.41; P <.001) and a prolonged T-wave onset to T-wave peak (T-onset to T-peak) (HR 1.13; 95% CI 1.07–1.20; P <.001). Marked prolongation of the ST segment (HR 1.31; 95% CI 1.04–1.64; P =.022) and T-onset to T-peak (HR 1.36; 95% CI 1.09–1.69; P =.006) was also associated with an increased risk of incident AF. Conclusion The association between a prolonged QT interval and incident AF is primarily explained by components involved in ventricular repolarization: prolongation of the ST segment and T-onset to T-peak. These observations suggest that prolongation of phases 2 and 3 of the cardiac action potential drives the association between the QT interval and AF risk.

AB - Background Prolongation of the QT interval has been associated with an increased risk of developing atrial fibrillation (AF), but the responsible mechanism remains unknown. Objectives The aims of this study were to subdivide the QT interval into its components and identify the resultant electrocardiographic interval(s) responsible for the association with AF. Methods Predefined QT-interval components were assessed for association with incident AF in the Atherosclerosis Risk in Communities study using Cox proportional hazards models. Hazard ratios (HRs) were calculated per 1-SD increase in each component. Among QT-interval components exhibiting significant associations, additional analyses evaluating long extremes, defined as greater than the 95th percentile, were performed. Results Of the 14,625 individuals, 1505 (10.3%) were diagnosed with incident AF during a mean follow-up period of 17.6 years. After multivariable adjustment, QT-interval components involved in repolarization, but not depolarization, exhibited significant associations with incident AF, including a longer ST segment (HR 1.27; 95% confidence interval [CI] 1.14–1.41; P <.001) and a prolonged T-wave onset to T-wave peak (T-onset to T-peak) (HR 1.13; 95% CI 1.07–1.20; P <.001). Marked prolongation of the ST segment (HR 1.31; 95% CI 1.04–1.64; P =.022) and T-onset to T-peak (HR 1.36; 95% CI 1.09–1.69; P =.006) was also associated with an increased risk of incident AF. Conclusion The association between a prolonged QT interval and incident AF is primarily explained by components involved in ventricular repolarization: prolongation of the ST segment and T-onset to T-peak. These observations suggest that prolongation of phases 2 and 3 of the cardiac action potential drives the association between the QT interval and AF risk.

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