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 (ECG) marker for conduction delay in atrial cardiomyopathy, which in turn is associated with AF. Objective: This study aimed to assess whether amplified PWD can predict incident AF in the general population. Methods: Amplified PWD was assessed manually on a signal-modified ECG in 2134 participants from the population-based Hamburg City Health Study. Incident AF during the 5-year follow-up was defined as the primary end point. Multivariable Cox regression models were constructed including significant clinical risk factors, ECG parameters, and transthoracic echocardiography parameters, and the predictive power for the primary end point was evaluated. Results: Over a median follow-up of 5.5 years, 102 participants (4.8%) developed incident AF. The upper tertile of amplified PWD was the only significant ECG-derived predictor for incident AF (hazard ratio [HR] 2.02; Conclusion: Amplified PWD as a novel ECG-based marker predicts incident AF in a population-based cohort and may provide a pragmatic ECG-derived marker of atrial cardiomyopathy for risk assessment beyond conventional risk stratification. Clinical Trial Registration: NCT03934957 (https://www.clinicaltrials.gov).