J-shaped association between QTc interval duration and the risk of atrial fibrillation: Results From the Copenhagen ECG Study

Jonas Bille Nielsen; Claus Graff; Adrian Pietersen; Bent Lind; Johannes Jan Struijk; Morten Salling Olesen; Stig Haunsø; Thomas Alexander Gerds; Jesper Hastrup Svendsen; Lars Køber; Anders Gaarsdal Holst

doi:10.1016/j.jacc.2013.03.032

J-shaped association between QTc interval duration and the risk of atrial fibrillation: Results From the Copenhagen ECG Study

Jonas Bille Nielsen, Claus Graff, Adrian Pietersen, Bent Lind, Johannes Jan Struijk, Morten Salling Olesen, Stig Haunsø, Thomas Alexander Gerds, Jesper Hastrup Svendsen, Lars Køber, Anders Gaarsdal Holst

82 Citations (Scopus)

Abstract

Objectives The aim of this study was to investigate whether the heart rate-corrected QT (QTc) interval on the electrocardiogram (ECG) is associated with the onset of atrial fibrillation (AF). Background Patients with hereditary short-QT or long-QT syndromes, representing the very extremes of the QT interval, both seem to have a high prevalence of AF. Methods A total of 281,277 subjects were included, corresponding to one-third of the population of the greater region of Copenhagen. These subjects underwent digital ECG recordings in a general practitioner's core facility from 2001 to 2010. Data on drug use, comorbidities, and outcomes were collected from Danish registries. Results After a median follow-up period of 5.7 years, 10,766 subjects had developed AF, of whom 1,467 (14%) developed lone AF. Having a QTc interval lower than the first percentile (≤372 ms) was associated with a multivariate-adjusted hazard ratio of 1.45 (95% confidence interval: 1.14 to 1.84; p = 0.002) of AF, compared with the reference group (411 to 419 ms). From the reference group and upward, the risk of AF increased with QTc interval duration in a dose-response manner, reaching a hazard ratio of 1.44 (95% confidence interval: 1.24 to 1.66, p < 0.001) for those with QTc intervals ≥99th percentile (≥464 ms). The association with respect to longer QTc intervals was stronger for the outcome of lone AF, as evidenced by a hazard ratio of 2.32 (95% confidence interval: 1.52 to 3.54, p < 0.001) for having a QTc interval ≥99th percentile (≥458 ms). Conclusions In this large ECG study, a J-shaped association was found between QTc interval duration and risk of AF. This association was strongest with respect to the development of lone AF.

Original language	English
Journal	Journal of the American College of Cardiology
Volume	61
Issue number	25
Pages (from-to)	2557-2564
Number of pages	8
ISSN	0735-1097
DOIs	https://doi.org/10.1016/j.jacc.2013.03.032
Publication status	Published - 25 Jun 2013

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10.1016/j.jacc.2013.03.032

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Nielsen, J. B., Graff, C., Pietersen, A., Lind, B., Struijk, J. J., Olesen, M. S., Haunsø, S., Gerds, T. A., Svendsen, J. H., Køber, L., & Holst, A. G. (2013). J-shaped association between QTc interval duration and the risk of atrial fibrillation: Results From the Copenhagen ECG Study. Journal of the American College of Cardiology, 61(25), 2557-2564. https://doi.org/10.1016/j.jacc.2013.03.032

J-shaped association between QTc interval duration and the risk of atrial fibrillation : Results From the Copenhagen ECG Study. / Nielsen, Jonas Bille; Graff, Claus; Pietersen, Adrian et al.

In: Journal of the American College of Cardiology, Vol. 61, No. 25, 25.06.2013, p. 2557-2564.

Research output: Contribution to journal › Journal article › Research › peer-review

Nielsen, JB, Graff, C, Pietersen, A, Lind, B, Struijk, JJ, Olesen, MS, Haunsø, S, Gerds, TA, Svendsen, JH, Køber, L & Holst, AG 2013, 'J-shaped association between QTc interval duration and the risk of atrial fibrillation: Results From the Copenhagen ECG Study', Journal of the American College of Cardiology, vol. 61, no. 25, pp. 2557-2564. https://doi.org/10.1016/j.jacc.2013.03.032

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title = "J-shaped association between QTc interval duration and the risk of atrial fibrillation: Results From the Copenhagen ECG Study",

abstract = "Objectives The aim of this study was to investigate whether the heart rate-corrected QT (QTc) interval on the electrocardiogram (ECG) is associated with the onset of atrial fibrillation (AF). Background Patients with hereditary short-QT or long-QT syndromes, representing the very extremes of the QT interval, both seem to have a high prevalence of AF. Methods A total of 281,277 subjects were included, corresponding to one-third of the population of the greater region of Copenhagen. These subjects underwent digital ECG recordings in a general practitioner's core facility from 2001 to 2010. Data on drug use, comorbidities, and outcomes were collected from Danish registries. Results After a median follow-up period of 5.7 years, 10,766 subjects had developed AF, of whom 1,467 (14%) developed lone AF. Having a QTc interval lower than the first percentile (≤372 ms) was associated with a multivariate-adjusted hazard ratio of 1.45 (95% confidence interval: 1.14 to 1.84; p = 0.002) of AF, compared with the reference group (411 to 419 ms). From the reference group and upward, the risk of AF increased with QTc interval duration in a dose-response manner, reaching a hazard ratio of 1.44 (95% confidence interval: 1.24 to 1.66, p < 0.001) for those with QTc intervals ≥99th percentile (≥464 ms). The association with respect to longer QTc intervals was stronger for the outcome of lone AF, as evidenced by a hazard ratio of 2.32 (95% confidence interval: 1.52 to 3.54, p < 0.001) for having a QTc interval ≥99th percentile (≥458 ms). Conclusions In this large ECG study, a J-shaped association was found between QTc interval duration and risk of AF. This association was strongest with respect to the development of lone AF.",

author = "Nielsen, {Jonas Bille} and Claus Graff and Adrian Pietersen and Bent Lind and Struijk, {Johannes Jan} and Olesen, {Morten Salling} and Stig Hauns{\o} and Gerds, {Thomas Alexander} and Svendsen, {Jesper Hastrup} and Lars K{\o}ber and Holst, {Anders Gaarsdal}",

year = "2013",

month = jun,

day = "25",

doi = "10.1016/j.jacc.2013.03.032",

language = "English",

volume = "61",

pages = "2557--2564",

journal = "Journal of the American College of Cardiology",

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TY - JOUR

T1 - J-shaped association between QTc interval duration and the risk of atrial fibrillation

T2 - Results From the Copenhagen ECG Study

AU - Nielsen, Jonas Bille

AU - Graff, Claus

AU - Pietersen, Adrian

AU - Lind, Bent

AU - Struijk, Johannes Jan

AU - Olesen, Morten Salling

AU - Haunsø, Stig

AU - Gerds, Thomas Alexander

AU - Svendsen, Jesper Hastrup

AU - Køber, Lars

AU - Holst, Anders Gaarsdal

PY - 2013/6/25

Y1 - 2013/6/25

N2 - Objectives The aim of this study was to investigate whether the heart rate-corrected QT (QTc) interval on the electrocardiogram (ECG) is associated with the onset of atrial fibrillation (AF). Background Patients with hereditary short-QT or long-QT syndromes, representing the very extremes of the QT interval, both seem to have a high prevalence of AF. Methods A total of 281,277 subjects were included, corresponding to one-third of the population of the greater region of Copenhagen. These subjects underwent digital ECG recordings in a general practitioner's core facility from 2001 to 2010. Data on drug use, comorbidities, and outcomes were collected from Danish registries. Results After a median follow-up period of 5.7 years, 10,766 subjects had developed AF, of whom 1,467 (14%) developed lone AF. Having a QTc interval lower than the first percentile (≤372 ms) was associated with a multivariate-adjusted hazard ratio of 1.45 (95% confidence interval: 1.14 to 1.84; p = 0.002) of AF, compared with the reference group (411 to 419 ms). From the reference group and upward, the risk of AF increased with QTc interval duration in a dose-response manner, reaching a hazard ratio of 1.44 (95% confidence interval: 1.24 to 1.66, p < 0.001) for those with QTc intervals ≥99th percentile (≥464 ms). The association with respect to longer QTc intervals was stronger for the outcome of lone AF, as evidenced by a hazard ratio of 2.32 (95% confidence interval: 1.52 to 3.54, p < 0.001) for having a QTc interval ≥99th percentile (≥458 ms). Conclusions In this large ECG study, a J-shaped association was found between QTc interval duration and risk of AF. This association was strongest with respect to the development of lone AF.

AB - Objectives The aim of this study was to investigate whether the heart rate-corrected QT (QTc) interval on the electrocardiogram (ECG) is associated with the onset of atrial fibrillation (AF). Background Patients with hereditary short-QT or long-QT syndromes, representing the very extremes of the QT interval, both seem to have a high prevalence of AF. Methods A total of 281,277 subjects were included, corresponding to one-third of the population of the greater region of Copenhagen. These subjects underwent digital ECG recordings in a general practitioner's core facility from 2001 to 2010. Data on drug use, comorbidities, and outcomes were collected from Danish registries. Results After a median follow-up period of 5.7 years, 10,766 subjects had developed AF, of whom 1,467 (14%) developed lone AF. Having a QTc interval lower than the first percentile (≤372 ms) was associated with a multivariate-adjusted hazard ratio of 1.45 (95% confidence interval: 1.14 to 1.84; p = 0.002) of AF, compared with the reference group (411 to 419 ms). From the reference group and upward, the risk of AF increased with QTc interval duration in a dose-response manner, reaching a hazard ratio of 1.44 (95% confidence interval: 1.24 to 1.66, p < 0.001) for those with QTc intervals ≥99th percentile (≥464 ms). The association with respect to longer QTc intervals was stronger for the outcome of lone AF, as evidenced by a hazard ratio of 2.32 (95% confidence interval: 1.52 to 3.54, p < 0.001) for having a QTc interval ≥99th percentile (≥458 ms). Conclusions In this large ECG study, a J-shaped association was found between QTc interval duration and risk of AF. This association was strongest with respect to the development of lone AF.

U2 - 10.1016/j.jacc.2013.03.032

DO - 10.1016/j.jacc.2013.03.032

M3 - Journal article

C2 - 23583581

SN - 0735-1097

VL - 61

SP - 2557

EP - 2564

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 25

ER -

J-shaped association between QTc interval duration and the risk of atrial fibrillation: Results From the Copenhagen ECG Study

Abstract

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