Electrocardiographic Preexcitation and Risk of Cardiovascular Morbidity and Mortality: Results from the Copenhagen ECG Study

Morten W. Skov; Peter V. Rasmussen; Jonas Ghouse; Steen M. Hansen; Claus Graff; Morten S. Olesen; Adrian Pietersen; Christian Torp-Pedersen; Stig Haunsø; Lars Køber; Jesper H. Svendsen; Anders G. Holst; Jonas B. Nielsen

doi:10.1161/CIRCEP.116.004778

Electrocardiographic Preexcitation and Risk of Cardiovascular Morbidity and Mortality: Results from the Copenhagen ECG Study

Morten W. Skov, Peter V. Rasmussen, Jonas Ghouse, Steen M. Hansen, Claus Graff, Morten S. Olesen, Adrian Pietersen, Christian Torp-Pedersen, Stig Haunsø, Lars Køber, Jesper H. Svendsen, Anders G. Holst, Jonas B. Nielsen^*

^*Corresponding author for this work

Department of Clinical Medicine

12 Citations (Scopus)

Abstract

Background - The majority of available data on the clinical course of patients with ventricular preexcitation in the ECG originates from tertiary centers. We aimed to investigate long-term outcomes in individuals from a primary care population with electrocardiographic preexcitation. Methods and Results - Digital ECGs from 328 638 primary care patients were collected during 2001 to 2011. We identified 310 individuals with preexcitation (age range, 8-85 years). Data on medication, comorbidity, and outcomes were collected from Danish nationwide registries. The median follow-up time was 7.4 years (quartiles, 4.6-10.3 years). Compared with the remainder of the population, patients with preexcitation had higher adjusted hazards of atrial fibrillation (hazard ratio [HR], 3.12; 95% confidence interval [CI], 2.07-4.70) and heart failure (HR, 2.11; 95% CI, 1.27-3.50). Subgroup analysis on accessory pathway location revealed a higher adjusted hazard of heart failure for a right anteroseptal accessory pathway (HR, 5.88; 95% CI, 2.63-13.1). There was no evidence of a higher hazard of death among individuals with preexcitation when looking across all age groups (HR, 1.07; 95% CI, 0.68-1.68). However, a statistically significant (P=0.01) interaction analysis (<65 versus ≥65 years) indicated a higher hazard of death for patients with preexcitation ≥65 years (HR, 1.85; 95% CI, 1.07-3.18). Conclusions - In this large ECG study, individuals with preexcitation had higher hazards of atrial fibrillation and heart failure. The higher hazard of heart failure seemed to be driven by a right anteroseptal accessory pathway. Among elderly people, we found a statistically significant association between preexcitation and a higher hazard of death.

Original language	English
Article number	e004778
Journal	Circulation: Arrhythmia and Electrophysiology
Volume	10
Issue number	6
Number of pages	11
ISSN	1941-3149
DOIs	https://doi.org/10.1161/CIRCEP.116.004778
Publication status	Published - Jun 2017

Keywords

atrial fibrillation
death
electrocardiography
heart failure
Wolff-Parkinson-White syndrome

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10.1161/CIRCEP.116.004778

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Skov, M. W., Rasmussen, P. V., Ghouse, J., Hansen, S. M., Graff, C., Olesen, M. S., Pietersen, A., Torp-Pedersen, C., Haunsø, S., Køber, L., Svendsen, J. H., Holst, A. G., & Nielsen, J. B. (2017). Electrocardiographic Preexcitation and Risk of Cardiovascular Morbidity and Mortality: Results from the Copenhagen ECG Study. Circulation: Arrhythmia and Electrophysiology, 10(6), [e004778]. https://doi.org/10.1161/CIRCEP.116.004778

Skov, MW, Rasmussen, PV, Ghouse, J, Hansen, SM, Graff, C, Olesen, MS, Pietersen, A, Torp-Pedersen, C, Haunsø, S, Køber, L, Svendsen, JH, Holst, AG & Nielsen, JB 2017, 'Electrocardiographic Preexcitation and Risk of Cardiovascular Morbidity and Mortality: Results from the Copenhagen ECG Study', Circulation: Arrhythmia and Electrophysiology, vol. 10, no. 6, e004778. https://doi.org/10.1161/CIRCEP.116.004778

@article{c14f3d8f98c44b3d9ab52e7101eac489,

title = "Electrocardiographic Preexcitation and Risk of Cardiovascular Morbidity and Mortality: Results from the Copenhagen ECG Study",

abstract = "Background - The majority of available data on the clinical course of patients with ventricular preexcitation in the ECG originates from tertiary centers. We aimed to investigate long-term outcomes in individuals from a primary care population with electrocardiographic preexcitation. Methods and Results - Digital ECGs from 328 638 primary care patients were collected during 2001 to 2011. We identified 310 individuals with preexcitation (age range, 8-85 years). Data on medication, comorbidity, and outcomes were collected from Danish nationwide registries. The median follow-up time was 7.4 years (quartiles, 4.6-10.3 years). Compared with the remainder of the population, patients with preexcitation had higher adjusted hazards of atrial fibrillation (hazard ratio [HR], 3.12; 95% confidence interval [CI], 2.07-4.70) and heart failure (HR, 2.11; 95% CI, 1.27-3.50). Subgroup analysis on accessory pathway location revealed a higher adjusted hazard of heart failure for a right anteroseptal accessory pathway (HR, 5.88; 95% CI, 2.63-13.1). There was no evidence of a higher hazard of death among individuals with preexcitation when looking across all age groups (HR, 1.07; 95% CI, 0.68-1.68). However, a statistically significant (P=0.01) interaction analysis (<65 versus ≥65 years) indicated a higher hazard of death for patients with preexcitation ≥65 years (HR, 1.85; 95% CI, 1.07-3.18). Conclusions - In this large ECG study, individuals with preexcitation had higher hazards of atrial fibrillation and heart failure. The higher hazard of heart failure seemed to be driven by a right anteroseptal accessory pathway. Among elderly people, we found a statistically significant association between preexcitation and a higher hazard of death.",

keywords = "atrial fibrillation, death, electrocardiography, heart failure, Wolff-Parkinson-White syndrome",

author = "Skov, {Morten W.} and Rasmussen, {Peter V.} and Jonas Ghouse and Hansen, {Steen M.} and Claus Graff and Olesen, {Morten S.} and Adrian Pietersen and Christian Torp-Pedersen and Stig Hauns{\o} and Lars K{\o}ber and Svendsen, {Jesper H.} and Holst, {Anders G.} and Nielsen, {Jonas B.}",

year = "2017",

month = jun,

doi = "10.1161/CIRCEP.116.004778",

language = "English",

volume = "10",

journal = "Circulation: Arrhythmia and Electrophysiology",

issn = "1941-3149",

publisher = "Lippincott Williams & Wilkins",

number = "6",

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TY - JOUR

T1 - Electrocardiographic Preexcitation and Risk of Cardiovascular Morbidity and Mortality

T2 - Results from the Copenhagen ECG Study

AU - Skov, Morten W.

AU - Rasmussen, Peter V.

AU - Ghouse, Jonas

AU - Hansen, Steen M.

AU - Graff, Claus

AU - Olesen, Morten S.

AU - Pietersen, Adrian

AU - Torp-Pedersen, Christian

AU - Haunsø, Stig

AU - Køber, Lars

AU - Svendsen, Jesper H.

AU - Holst, Anders G.

AU - Nielsen, Jonas B.

PY - 2017/6

Y1 - 2017/6

N2 - Background - The majority of available data on the clinical course of patients with ventricular preexcitation in the ECG originates from tertiary centers. We aimed to investigate long-term outcomes in individuals from a primary care population with electrocardiographic preexcitation. Methods and Results - Digital ECGs from 328 638 primary care patients were collected during 2001 to 2011. We identified 310 individuals with preexcitation (age range, 8-85 years). Data on medication, comorbidity, and outcomes were collected from Danish nationwide registries. The median follow-up time was 7.4 years (quartiles, 4.6-10.3 years). Compared with the remainder of the population, patients with preexcitation had higher adjusted hazards of atrial fibrillation (hazard ratio [HR], 3.12; 95% confidence interval [CI], 2.07-4.70) and heart failure (HR, 2.11; 95% CI, 1.27-3.50). Subgroup analysis on accessory pathway location revealed a higher adjusted hazard of heart failure for a right anteroseptal accessory pathway (HR, 5.88; 95% CI, 2.63-13.1). There was no evidence of a higher hazard of death among individuals with preexcitation when looking across all age groups (HR, 1.07; 95% CI, 0.68-1.68). However, a statistically significant (P=0.01) interaction analysis (<65 versus ≥65 years) indicated a higher hazard of death for patients with preexcitation ≥65 years (HR, 1.85; 95% CI, 1.07-3.18). Conclusions - In this large ECG study, individuals with preexcitation had higher hazards of atrial fibrillation and heart failure. The higher hazard of heart failure seemed to be driven by a right anteroseptal accessory pathway. Among elderly people, we found a statistically significant association between preexcitation and a higher hazard of death.

AB - Background - The majority of available data on the clinical course of patients with ventricular preexcitation in the ECG originates from tertiary centers. We aimed to investigate long-term outcomes in individuals from a primary care population with electrocardiographic preexcitation. Methods and Results - Digital ECGs from 328 638 primary care patients were collected during 2001 to 2011. We identified 310 individuals with preexcitation (age range, 8-85 years). Data on medication, comorbidity, and outcomes were collected from Danish nationwide registries. The median follow-up time was 7.4 years (quartiles, 4.6-10.3 years). Compared with the remainder of the population, patients with preexcitation had higher adjusted hazards of atrial fibrillation (hazard ratio [HR], 3.12; 95% confidence interval [CI], 2.07-4.70) and heart failure (HR, 2.11; 95% CI, 1.27-3.50). Subgroup analysis on accessory pathway location revealed a higher adjusted hazard of heart failure for a right anteroseptal accessory pathway (HR, 5.88; 95% CI, 2.63-13.1). There was no evidence of a higher hazard of death among individuals with preexcitation when looking across all age groups (HR, 1.07; 95% CI, 0.68-1.68). However, a statistically significant (P=0.01) interaction analysis (<65 versus ≥65 years) indicated a higher hazard of death for patients with preexcitation ≥65 years (HR, 1.85; 95% CI, 1.07-3.18). Conclusions - In this large ECG study, individuals with preexcitation had higher hazards of atrial fibrillation and heart failure. The higher hazard of heart failure seemed to be driven by a right anteroseptal accessory pathway. Among elderly people, we found a statistically significant association between preexcitation and a higher hazard of death.

KW - atrial fibrillation

KW - death

KW - electrocardiography

KW - heart failure

KW - Wolff-Parkinson-White syndrome

U2 - 10.1161/CIRCEP.116.004778

DO - 10.1161/CIRCEP.116.004778

M3 - Journal article

C2 - 28576781

AN - SCOPUS:85021065225

SN - 1941-3149

VL - 10

JO - Circulation: Arrhythmia and Electrophysiology

JF - Circulation: Arrhythmia and Electrophysiology

IS - 6

M1 - e004778

ER -

Electrocardiographic Preexcitation and Risk of Cardiovascular Morbidity and Mortality: Results from the Copenhagen ECG Study

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Keywords

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