P wave analysis with wavelets identifies hypertensive patients at risk of recurrence of atrial fibrillation: A case-control study and 1 year follow-up

George Dakos, Dimitrios Konstantinou, Yiannis S. Chatzizisis, Ioanna Chouvarda, Dimitrios Filos, Stylianos Paraskevaidis, Lilian Mantziari, Nicos Maglaveras, Haralambos Karvounis, Vassilios Vassilikos

Research output: Contribution to journalArticle

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Abstract

Aims Hypertension is a major risk factor for atrial fibrillation (AF); however, reliable non-invasive tools to assess AF risk in hypertensive patients are lacking. We sought to evaluate the efficacy of P wave wavelet analysis in predicting AF risk recurrence in a hypertensive cohort. Methods We studied 37 hypertensive patients who presented with an AF episode for the first time and 37 age- and sex-matched hypertensive controls without AF. P wave duration and energy variables were measured for each subject [i.e. mean and max P wave energy along horizontal (x), coronal (y) and sagittal (z) axes in low, intermediate and high frequency bands]. AF-free survival was assessed over a follow-up of 12.1 ± 0.4 months. Results P wave duration (Pdurz) and mean P wave energy in the intermediate frequency band across sagittal axis (mean2z) were independently associated with baseline AF status (p = 0.008 and p = 0.001, respectively). Based on optimal cut-off points, four groups were formed: Pdurz < 83.2 ms/mean2z < 6.2 μV2 (n = 23), Pdurz < 83.2 ms/mean2z ≥6.2 μV2 (n = 10), Pdurz ≥83.2 ms/mean2z < 6.2 μV2 (n = 22) and Pdurz ≥83.2 ms/mean2z ≥6.2 μV2 (n = 19). AF-free survival decreased (Log Rank p < 0.0001) from low risk (Pdurz < 83.2 ms/mean2z < 6.2 μV2) to high-risk group (Pdurz ≥83.2 ms/mean2z ≥6.2 μV2). Patients presenting with longer and higher energy P waves were at 18 times higher AF risk compared to those with neither (OR: 17.6, 95% CI: 3.7-84.3) even after adjustment for age, sex, hypertension duration, left atrial size, beta-blocker, ACEi/ARBs and statin therapy. Conclusions P wave temporal and energy characteristics extracted using wavelet analysis can potentially serve as screening tool to identify hypertensive patients at risk of AF recurrence.

Original languageEnglish (US)
Pages (from-to)845-852
Number of pages8
JournalJournal of Electrocardiology
Volume48
Issue number5
DOIs
StatePublished - Sep 1 2015

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Wavelet Analysis
Atrial Fibrillation
Case-Control Studies
Recurrence
Hypertension
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Survival

Keywords

  • Atrial fibrillation
  • Hypertension
  • Orthogonal ECG
  • P wave wavelet analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

P wave analysis with wavelets identifies hypertensive patients at risk of recurrence of atrial fibrillation : A case-control study and 1 year follow-up. / Dakos, George; Konstantinou, Dimitrios; Chatzizisis, Yiannis S.; Chouvarda, Ioanna; Filos, Dimitrios; Paraskevaidis, Stylianos; Mantziari, Lilian; Maglaveras, Nicos; Karvounis, Haralambos; Vassilikos, Vassilios.

In: Journal of Electrocardiology, Vol. 48, No. 5, 01.09.2015, p. 845-852.

Research output: Contribution to journalArticle

Dakos, G, Konstantinou, D, Chatzizisis, YS, Chouvarda, I, Filos, D, Paraskevaidis, S, Mantziari, L, Maglaveras, N, Karvounis, H & Vassilikos, V 2015, 'P wave analysis with wavelets identifies hypertensive patients at risk of recurrence of atrial fibrillation: A case-control study and 1 year follow-up', Journal of Electrocardiology, vol. 48, no. 5, pp. 845-852. https://doi.org/10.1016/j.jelectrocard.2015.07.012
Dakos, George ; Konstantinou, Dimitrios ; Chatzizisis, Yiannis S. ; Chouvarda, Ioanna ; Filos, Dimitrios ; Paraskevaidis, Stylianos ; Mantziari, Lilian ; Maglaveras, Nicos ; Karvounis, Haralambos ; Vassilikos, Vassilios. / P wave analysis with wavelets identifies hypertensive patients at risk of recurrence of atrial fibrillation : A case-control study and 1 year follow-up. In: Journal of Electrocardiology. 2015 ; Vol. 48, No. 5. pp. 845-852.
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abstract = "Aims Hypertension is a major risk factor for atrial fibrillation (AF); however, reliable non-invasive tools to assess AF risk in hypertensive patients are lacking. We sought to evaluate the efficacy of P wave wavelet analysis in predicting AF risk recurrence in a hypertensive cohort. Methods We studied 37 hypertensive patients who presented with an AF episode for the first time and 37 age- and sex-matched hypertensive controls without AF. P wave duration and energy variables were measured for each subject [i.e. mean and max P wave energy along horizontal (x), coronal (y) and sagittal (z) axes in low, intermediate and high frequency bands]. AF-free survival was assessed over a follow-up of 12.1 ± 0.4 months. Results P wave duration (Pdurz) and mean P wave energy in the intermediate frequency band across sagittal axis (mean2z) were independently associated with baseline AF status (p = 0.008 and p = 0.001, respectively). Based on optimal cut-off points, four groups were formed: Pdurz < 83.2 ms/mean2z < 6.2 μV2 (n = 23), Pdurz < 83.2 ms/mean2z ≥6.2 μV2 (n = 10), Pdurz ≥83.2 ms/mean2z < 6.2 μV2 (n = 22) and Pdurz ≥83.2 ms/mean2z ≥6.2 μV2 (n = 19). AF-free survival decreased (Log Rank p < 0.0001) from low risk (Pdurz < 83.2 ms/mean2z < 6.2 μV2) to high-risk group (Pdurz ≥83.2 ms/mean2z ≥6.2 μV2). Patients presenting with longer and higher energy P waves were at 18 times higher AF risk compared to those with neither (OR: 17.6, 95{\%} CI: 3.7-84.3) even after adjustment for age, sex, hypertension duration, left atrial size, beta-blocker, ACEi/ARBs and statin therapy. Conclusions P wave temporal and energy characteristics extracted using wavelet analysis can potentially serve as screening tool to identify hypertensive patients at risk of AF recurrence.",
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author = "George Dakos and Dimitrios Konstantinou and Chatzizisis, {Yiannis S.} and Ioanna Chouvarda and Dimitrios Filos and Stylianos Paraskevaidis and Lilian Mantziari and Nicos Maglaveras and Haralambos Karvounis and Vassilios Vassilikos",
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T1 - P wave analysis with wavelets identifies hypertensive patients at risk of recurrence of atrial fibrillation

T2 - A case-control study and 1 year follow-up

AU - Dakos, George

AU - Konstantinou, Dimitrios

AU - Chatzizisis, Yiannis S.

AU - Chouvarda, Ioanna

AU - Filos, Dimitrios

AU - Paraskevaidis, Stylianos

AU - Mantziari, Lilian

AU - Maglaveras, Nicos

AU - Karvounis, Haralambos

AU - Vassilikos, Vassilios

PY - 2015/9/1

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N2 - Aims Hypertension is a major risk factor for atrial fibrillation (AF); however, reliable non-invasive tools to assess AF risk in hypertensive patients are lacking. We sought to evaluate the efficacy of P wave wavelet analysis in predicting AF risk recurrence in a hypertensive cohort. Methods We studied 37 hypertensive patients who presented with an AF episode for the first time and 37 age- and sex-matched hypertensive controls without AF. P wave duration and energy variables were measured for each subject [i.e. mean and max P wave energy along horizontal (x), coronal (y) and sagittal (z) axes in low, intermediate and high frequency bands]. AF-free survival was assessed over a follow-up of 12.1 ± 0.4 months. Results P wave duration (Pdurz) and mean P wave energy in the intermediate frequency band across sagittal axis (mean2z) were independently associated with baseline AF status (p = 0.008 and p = 0.001, respectively). Based on optimal cut-off points, four groups were formed: Pdurz < 83.2 ms/mean2z < 6.2 μV2 (n = 23), Pdurz < 83.2 ms/mean2z ≥6.2 μV2 (n = 10), Pdurz ≥83.2 ms/mean2z < 6.2 μV2 (n = 22) and Pdurz ≥83.2 ms/mean2z ≥6.2 μV2 (n = 19). AF-free survival decreased (Log Rank p < 0.0001) from low risk (Pdurz < 83.2 ms/mean2z < 6.2 μV2) to high-risk group (Pdurz ≥83.2 ms/mean2z ≥6.2 μV2). Patients presenting with longer and higher energy P waves were at 18 times higher AF risk compared to those with neither (OR: 17.6, 95% CI: 3.7-84.3) even after adjustment for age, sex, hypertension duration, left atrial size, beta-blocker, ACEi/ARBs and statin therapy. Conclusions P wave temporal and energy characteristics extracted using wavelet analysis can potentially serve as screening tool to identify hypertensive patients at risk of AF recurrence.

AB - Aims Hypertension is a major risk factor for atrial fibrillation (AF); however, reliable non-invasive tools to assess AF risk in hypertensive patients are lacking. We sought to evaluate the efficacy of P wave wavelet analysis in predicting AF risk recurrence in a hypertensive cohort. Methods We studied 37 hypertensive patients who presented with an AF episode for the first time and 37 age- and sex-matched hypertensive controls without AF. P wave duration and energy variables were measured for each subject [i.e. mean and max P wave energy along horizontal (x), coronal (y) and sagittal (z) axes in low, intermediate and high frequency bands]. AF-free survival was assessed over a follow-up of 12.1 ± 0.4 months. Results P wave duration (Pdurz) and mean P wave energy in the intermediate frequency band across sagittal axis (mean2z) were independently associated with baseline AF status (p = 0.008 and p = 0.001, respectively). Based on optimal cut-off points, four groups were formed: Pdurz < 83.2 ms/mean2z < 6.2 μV2 (n = 23), Pdurz < 83.2 ms/mean2z ≥6.2 μV2 (n = 10), Pdurz ≥83.2 ms/mean2z < 6.2 μV2 (n = 22) and Pdurz ≥83.2 ms/mean2z ≥6.2 μV2 (n = 19). AF-free survival decreased (Log Rank p < 0.0001) from low risk (Pdurz < 83.2 ms/mean2z < 6.2 μV2) to high-risk group (Pdurz ≥83.2 ms/mean2z ≥6.2 μV2). Patients presenting with longer and higher energy P waves were at 18 times higher AF risk compared to those with neither (OR: 17.6, 95% CI: 3.7-84.3) even after adjustment for age, sex, hypertension duration, left atrial size, beta-blocker, ACEi/ARBs and statin therapy. Conclusions P wave temporal and energy characteristics extracted using wavelet analysis can potentially serve as screening tool to identify hypertensive patients at risk of AF recurrence.

KW - Atrial fibrillation

KW - Hypertension

KW - Orthogonal ECG

KW - P wave wavelet analysis

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