QRS duration predicts death and hospitalization among patients with atrial fibrillation irrespective of heart failure: evidence from the AFFIRM study

Whitbeck, Matthew G.; Charnigo, Richard; Shah, Jignesh; Morales, Gustavo; Leung, Steve W.; Fornwalt, Brandon K.; Bailey, Alison L.; Ziada, Khaled M.; Sorrell, Vincent L.; Zegarra, Milagros M.; Thompson, Joel C.; Hosn, Neil Aboul; Campbell, Charles L.; Gurley, John C.; Anaya, Paul; Booth, David C.; Biase, Luigi Di; Natale, Andrea; Smyth, Susan S.; Moliterno, David J.; Elayi, Claude S.

doi:10.1093/europace/eut335

Cited by 20 publications

(20 citation statements)

References 39 publications

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“…In another study with 3804 patients with AF, QRS duration was measured, and 12.9% of patients had QRS duration of $120 ms (46). Interestingly, QRS duration was shown to be an independent predictor of mortality and hospitalization (46). Prolonged QTc was also identified in patients with AF.…”

Section: Discussionmentioning

confidence: 97%

“…In a large study with a total of 25,268 patients with left ventricular dysfunction, a significant association was identified between prolonged QRS duration and AF after adjusting for all AF factors, including EF, New York Heart Association class, and etiology of cardiomyopathy, and prolonged QRS duration may predict the occurrence of AF (45). In another study with 3804 patients with AF, QRS duration was measured, and 12.9% of patients had QRS duration of $120 ms (46). Interestingly, QRS duration was shown to be an independent predictor of mortality and hospitalization (46).…”

Section: Discussionmentioning

confidence: 99%

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Mutation in NPPA causes atrial fibrillation by activating inflammation and cardiac fibrosis in a knock‐in rat model

et al. 2019

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Atrial fibrillation (AF) affects >30 million individuals worldwide. However, no genetic mutation from human patients with AF has been linked to inflammation. Here, we show that AF‐associated human variant p.Ile138Thr in natriuretic peptide A (NPPA) encoding the atrial natriuretic peptide (ANP) causes inflammation, fibroblast activation, atrial fibrosis, and AF in knock‐in (KI) rats. Variant p.Ile138Thr inhibits the interaction between ANP and its receptor natriuretic peptide receptor A and reduces intracellular cGMP levels. RNA sequencing and follow‐up analyses showed that mutant ANP (mANP) activates multiple innate immunity pathways, including TNF‐α, NF‐κB, and IL‐1β signaling. mANP induces differentiation of cardiac fibroblasts (CFs) to myofibroblasts and promotes CF proliferation and fibrosis. These results suggest that NPPA variant p.Ile138Thr causes AF by activating TNF‐α, NF‐κB, and IL‐1β signaling, inflammation, and fibrosis. Multiple computational programs suggest that p.Ile138Thr is damaging or deleterious. Based on the 2015 American College of Medical Genetics and Genomics Standards and Guidelines, p.Ile138Thr can be classified as a likely pathogenic variant. Variant p.Ile138Thr was found only in Asian people in the Genome Aggregation Database and Exome Aggregation Consortium database at an averaged frequency of 0.026%. An estimated 1.15 million Asian people carry the variant and might be at risk of AF. The KI rats may provide an inflammation‐based, genetic animal model for AF valuable for testing anti‐inflammation or other therapies for AF.—Cheng, C., Liu, H., Tan, C., Tong, D., Zhao, Y., Liu, X., Si, W., Wang, L., Liang, L., Li, J., Wang, C., Chen, Q., Du, Y., Wang, Q. K., Ren, X. Mutation in NPPA causes atrial fibrillation by activating inflammation and cardiac fibrosis in a knock‐in rat model. FASEB J. 33, 8878–8891 (2019). http://www.fasebj.org

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Mutation in NPPA causes atrial fibrillation by activating inflammation and cardiac fibrosis in a knock‐in rat model

et al. 2019

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“…QRS duration (QRSd) represents the time of ventricular depolarization and depends on age, heart rate and sex, with a longer QRSd in men compared to women [10]. A prolonged QRSd on the resting electrocardiogram (ECG) is associated with cardiac structural and functional abnormalities [11, 12] and was shown to be an independent predictor of congestive HF [11, 13] and death [14]. Little evidence is available on the association between QRSd and incident AF.…”

Section: Introductionmentioning

confidence: 99%

Relationship between QRS duration and incident atrial fibrillation

Aeschbacher

O’Neal

Krisai

et al. 2018

International Journal of Cardiology

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“…In a study of 25,268 patients with left ventricular (LV) systolic dysfunction, 42% had a QRSd >120 ms, and QRSd was independently associated with AF . In addition, irrespective of HF status, QRSd has been shown to be an independent predictor of morbidity and mortality among patients with AF …”

Section: Introductionmentioning

confidence: 99%

“…9 In addition, irrespective of HF status, QRSd has been shown to be an independent predictor of morbidity and mortality among patients with AF. 10 To our knowledge, there are no studies where the primary objective was to examine ECG findings in patients with HFpEF, with and without AF. The purpose of this study was to examine whether QRSd is associated with AF prevalence in patients with HFpEF.…”

Section: Introductionmentioning

confidence: 99%

The association of QRS duration with atrial fibrillation in a heart failure with preserved ejection fraction population: a pilot study

Gigliotti

Sidhu

Robert

et al. 2017

Clinical Cardiology

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Background Heart failure is a significant cause of morbidity and mortality, yet patient risk stratification may be difficult. Prevention or treatment of atrial fibrillation (AF) may be an important strategy in these patients that could positively affect their outcome. It has been demonstrated that in patients with systolic dysfunction, prolonged QRS duration (QRSd), an easily measured electrocardiographic parameter, is associated with AF. Hypothesis Prolonged QRSd is associated with an increase in prevalence of AF in patients with heart failure with preserved ejection fraction(HFPEF). Methods Between February 2006 and February 2009, 718 patients were discharged with a diagnosis of HF from the Dartmouth‐Hitchcock Medical Center. Of these, 206 had EF ≥50% by echocardiography performed within 72 hours of admission. After exclusions, 82 patients remained, of which 25 had AF and 57 had sinus rhythm. Characteristics of the AF and sinus‐rhythm patients were compared in this pilot study. Results After adjustment for age, prior diagnosis of HF, and left atrial area, there was a nonsignificant trend (odds ratio: 2.2, 95% CI of 0.3‐17.2) for a QRSd >120 ms to be associated with AF. Conclusions Similar to results in patients with systolic dysfunction, patients with preserved EF may have an association between a prolonged QRSd and AF.

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QRS duration predicts death and hospitalization among patients with atrial fibrillation irrespective of heart failure: evidence from the AFFIRM study

Abstract: Among patients with AF, QRSd ≥ 120 ms was associated with a substantially increased risk for mortality (all-cause, cardiovascular, and arrhythmic) and hospitalization. Interestingly, an increased mortality was also observed among those with QRS 90-119 ms and concomitant HF.

Cited by 20 publications

References 39 publications

Mutation in NPPA causes atrial fibrillation by activating inflammation and cardiac fibrosis in a knock‐in rat model

Mutation in NPPA causes atrial fibrillation by activating inflammation and cardiac fibrosis in a knock‐in rat model

Relationship between QRS duration and incident atrial fibrillation

The association of QRS duration with atrial fibrillation in a heart failure with preserved ejection fraction population: a pilot study

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