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

Matthew G. Whitbeck, Richard J. Charnigo, Jignesh Shah, Gustavo Morales, Steve W. Leung, Brandon Fornwalt, Alison L. Bailey, Khaled Ziada, Vincent L. Sorrell, Milagros M. Zegarra, Jenks Thompson, Neil Aboul Hosn, Charles L. Campbell, John Gurley, Paul Anaya, David C. Booth, Luigi Di Biase, Andrea Natale, Susan Smyth, David J. Moliterno, Claude S. Elayi,
DOI: http://dx.doi.org/10.1093/europace/eut335 803-811 First published online: 24 December 2013

Abstract

Aims The association of QRS duration (QRSd) with morbidity and mortality is understudied in patients with atrial fibrillation (AF). We sought to assess any association of prolonged QRS with increased risk of death or hospitalization among patients with AF.

Methods and results QRS duration was retrieved from the baseline electrocardiograms of patients enroled in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study and divided into three categories: <90, 90–119, ≥120 ms. Cox models were applied relating the hazards of mortality and hospitalizations to QRSd. Among 3804 patients with AF, 593 died and 2305 were hospitalized. Compared with those with QRS < 90 ms, patients with QRS ≥ 120 ms, had an increased mortality [hazard ratio (HR) 1.61, 95% confidence interval (CI): 1.29–2.03, P < 0.001] and hospitalizations (HR 1.14, 95% CI: 1.07–1.34, P = 0.043) over an average follow-up of 3.5 years. Importantly, for patients with QRS 90–119 ms, mortality and hospitalization were also increased (HR 1.31, P = 0.005 and 1.11, P = 0.026, respectively). In subgroup analysis based on heart failure (HF) status (previously documented or ejection fraction <40%), mortality was increased for QRS ≥ 120 ms patients with (HR 1.87, P < 0.001) and without HF (HR 1.63, P = 0.02). In the QRS 90–119 ms group, mortality was increased (HR 1.38, P = 0.03) for those with HF, but not significantly among those without HF (HR 1.23, P = 0.14).

Conclusion 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.

  • Atrial fibrillation
  • Heart failure
  • QRS duration
  • Bundle branch block
  • Arrhythmia
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