Electrocardiographic parameters and the risk of new-onset atrial fibrillation in the general population

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University, Rotterdam, Netherlands Organization for the Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (RIDE), the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the European Commission (DG XII), and the Municipality of Rotterdam. This study is further supported by the Senior Scientist Grant from Dutch Heart Foundation (03-004-2021-T050). Background The (shape of the) association and sex-differences between electrocardiographic parameters and new-onset atrial fibrillation (AF) remain incompletely understood. Purpose To investigate the association between electrocardiographic parameters and new-onset atrial fibrillation among men and women in the general population. Methods 12,212 participants free of AF from a large population-based cohort study were included. Up to five repeated measurements of electrocardiographic parameters including PR, QRS, QT, QT corrected for heart rate (QTc), JT, RR interval, and heart rate were assessed at baseline and follow-up examinations. Cox proportional hazards models and joint models, both adjusted for cardiovascular risk factors, were used to determine the (shape of) association between baseline and longitudinal electrocardiographic parameters with new-onset AF. Additionally, we evaluated potential sex-differences. Results During a median follow-up of 9.3 years, 1,282 incident AF cases occurred among 12,212 participants (mean age 64.9 years, 58.2% women). Penalized cubic splines revealed that associations between baseline electrocardiographic measures and risk of new-onset AF were generally U-shaped (Figure 1). Sex-differences in terms of the shape of the various associations were most apparent for baseline PR, QT, QTc, RR, and heart rate in relation to new-onset AF. Longitudinal measures of PR (hazard ratio (HR), 95% confidence interval (CI), 1.43, 1.02-2.04, p=0.0393), and QTc interval (HR, 95% CI, 5.23, 2.18-12.45, p=0.0002) were significantly associated with new-onset AF. Sex-stratified analyses showed that the longitudinal associations were more prominent among men. Conclusions Baseline electrocardiographic measures and risk of new-onset AF were generally U-shaped. Longitudinal electrocardiographic measures of PR, and QTc interval were significantly associated with new-onset AF, more pronounced in men. Our findings imply that different thresholds of electrocardiographic parameters might translate to a differential risk of AF among men and women, and that treatment options targeting specific electrocardiographic parameters might prevent AF in the general population, in particular in men.