Interatrial block, P terminal force or fragmented QRS do not predict new-onset atrial fibrillation in patients with severe chronic kidney disease

• Published in: BMC cardiovascular disorders Vol. 20; no. 1; p. 437
• Main Authors: Hellman, Tapio, Hakamäki, Markus, Lankinen, Roosa, Koivuviita, Niina, Pärkkä, Jussi, Kallio, Petri, Kiviniemi, Tuomas, Airaksinen, K E Juhani, Järvisalo, Mikko J, Metsärinne, Kaj
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 07-10-2020; BioMed Central; BMC
• Subjects: Action Potentials; Aged; Atrial fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Atrial Fibrillation - physiopathology; Atrial Function, Left; Atrial Remodeling; Cardiac arrhythmia; Cardiovascular disease; Chronic kidney disease; Chronic kidney failure; Complications and side effects; Development and progression; Diagnosis; Dialysis; Electrocardiography; Electrophysiologic tests; Evaluation; Female; Fibrillation; Finland - epidemiology; Follow-Up Studies; Fragmented QRS; Glomerular filtration rate; Heart Conduction System - physiopathology; Heart failure; Heart Rate; Humans; Hypertension; Incidence; Kidney diseases; Laboratories; Left atrial enlargement; Male; Methods; Middle Aged; Mortality; Pacemakers; Patients; Predictive Value of Tests; Prevalence; Prospective Studies; Quality of life; Regression analysis; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - physiopathology; Risk Factors; Severity of Illness Index; Time Factors; Finland; Left atrial enlargement; Chronic kidney disease; Fragmented QRS; Atrial fibrillation; Incidence
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-020-01719-3

The prevalence of left atrial enlargement (LAE) and fragmented QRS (fQRS) diagnosed using ECG criteria in patients with severe chronic kidney disease (CKD) is unknown. Furthermore, there is limited data on predicting new-onset atrial fibrillation (AF) with LAE or fQRS in this patient group.
We enrolled 165 consecutive non-dialysis patients with CKD stage 4-5 without prior AF diagnosis between 2013 and 2017 in a prospective follow-up cohort study. LAE was defined as total P-wave duration ≥120 ms in lead II ± > 1 biphasic P-waves in leads II, III or aVF; or duration of terminal negative portion of P-wave > 40 ms or depth of terminal negative portion of P-wave > 1 mm in lead V
from a baseline ECG, respectively. fQRS was defined as the presence of a notched R or S wave or the presence of ≥1 additional R waves (R') or; in the presence of a wide QRS complex (> 120 ms), > 2 notches in R or S waves in two contiguous leads corresponding to a myocardial region, respectively.
Mean age of the patients was 59 (SD 14) years, 56/165 (33.9%) were female and the mean estimated glomerular filtration rate was 12.8 ml/min/1.73m
. Altogether 29/165 (17.6%) patients were observed with new-onset AF within median follow-up of 3 [IQR 3, range 2-6] years. At baseline, 137/165 (83.0%) and 144/165 (87.3%) patients were observed with LAE and fQRS, respectively. Furthermore, LAE and fQRS co-existed in 121/165 (73.3%) patients. Neither findings were associated with the risk of new-onset AF within follow-up.
The prevalence of LAE and fQRS at baseline in this study on CKD stage 4-5 patients not on dialysis was very high. However, LAE or fQRS failed to predict occurrence of new-onset AF in these patients.