Electrocardiographic Deep Terminal Negativity of the P Wave in V 1 and Risk of Sudden Cardiac Death: The Atherosclerosis Risk in Communities (ARIC) Study

Abstract

Background Identifying individuals at risk for sudden cardiac death ( SCD ) is of critical importance. Electrocardiographic ( ECG ) deep terminal negativity of P wave in V 1 ( DTNPV 1), a marker of left atrial abnormality, has been associated with increased risk of all‐cause and cardiovascular mortality. We hypothesized that DTNPV 1 is associated with increased risk of sudden cardiac death ( SCD ). Methods and Results This analysis included 15 375 participants (54.1±5.8 years, 45% men, 73% whites) from the Atherosclerosis Risk in Communities ( ARIC ) study. DTNPV 1 was defined from the resting 12‐lead ECG as presence of biphasic P wave (positive/negative) in V 1 with the amplitude of the terminal negative phase >100 μV, or one small box on ECG scale. After a median of 14 years of follow‐up, 311 cases of SCD occurred. In unadjusted Cox regression, DTNPV 1 was associated with an 8‐fold increased risk of SCD ( HR 8.21; [95% CI 5.27 to 12.79]). Stratified by race and study center, and adjusted for age, sex, coronary heart disease ( CHD ), and ECG risk factors, as well as atrial fibrillation ( AF ), stroke, CHD , and heart failure ( HF ) as time‐updated variables, the risk of SCD associated with DTNPV 1 remained significant (2.49, [1.51–4.10]). DTNPV 1 improved reclassification: additional 3.4% of individuals were appropriately reclassified into a higher SCD risk group, as compared with traditional CHD risk factors alone. In fully adjusted models DTNPV 1 was associated with increased risk of non‐fatal events: AF (5.02[3.23–7.80]), CHD (2.24[1.43–3.53]), HF (1.90[1.19–3.04]), and trended towards increased risk of stroke (1.88[0.99–3.57]). Conclusion DTNPV 1 is predictive of SCD suggesting its potential utility in risk stratification in the general population.