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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2017;70:841-7 - Vol. 70 Num.10 DOI: 10.1016/j.rec.2017.02.019

Analysis of the Association Between Electrocardiographic P-wave Characteristics and Atrial Fibrillation in the REGICOR Study

Albert Massó-van Roessel a, Luis Alberto Escobar-Robledo a, Irene R. Dégano b,c, María Grau b,c, Joan Sala d, Rafel Ramos e, Jaume Marrugat b,c, Antoni Bayés de Luna a, Roberto Elosua b,c,

a Instituto Catalán de Ciencias Cardiovasculares, Barcelona, Spain
b Grupo de Epidemiología y Genética Cardiovascular, Grupo del Estudio REGICOR, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
c CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Barcelona, Spain
d Servicio de Cardiología, Hospital Josep Trueta, Girona, Spain
e Instituto de Investigación en Atención Primaria Jordi Gol (IDIAP Jordi Gol), Grupo de Investigación en Salud Vascular (ISV), Unidad de Investigación en Atención Primaria, Instituto Catalán de Salud (ICS), Instituto de Investigación Biomédica de Girona (IdIBGi), Grupo de Investigación TransLab, Departamento de Medicina, Facultad de Medicina, Universidad de Girona, Girona, Spain


Atrial fibrillation. Interatrial blocks. P-wave duration.


Introduction and objectives

Atrial fibrillation (AF) is the most common clinically significant cardiac arrhythmia. P-wave duration and interatrial blocks (IAB) have been reported to be associated with AF. Our aim was to determine the individual and combined association of P-wave duration and advanced IAB morphology with AF.


We designed an age-, sex-, and survey-matched case-control study nested in a population-based cohort (REGICOR: REgistre GIroní del COR). Two different surveys recruited a total of 9380 participants from 1999 to 2005; all participants were invited to a second examination between 2009 and 2013. For the present study, we selected participants aged 25 to 79 years with follow-up through the end of the study. All electrocardiograms were analyzed by 2 observers to determine P-wave duration and morphology (normal, partial, or advanced IAB).


The median follow-up was 7.12 years. Eighty participants presented with AF, had a legible baseline electrocardiogram, and were included in the study, along with 160 controls. P-wave duration and the presence of partial or advanced IAB were associated with AF. When P-wave duration and morphology were considered together, only P-wave duration (≥ 110 milliseconds) showed an independent and strong association with AF. The odds ratio for AF of P-wave duration between 110-119, 120-129 and ≥ 130 milliseconds vs < 110 milliseconds were 5.33; 95%CI, 1.74-16.33, 5.08; 95%CI, 1.73-14.90 and 5.44; 95%CI, 1.95-15.15, respectively.


A P-wave longer than 110 milliseconds increases the risk of AF. Advanced IAB morphology did not seem to provide an additional AF risk beyond that of P-wave duration.


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1885-5857/© 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved