Atrial electrocardiography in obesity and hypertension: Clinical insights from the Polish-Norwegian Study (PONS)

Abstract

Objective: Obesity and hypertension often coexist and represent risk factors for atrial fibrillation. This study hypothesized that their single and joint effects on atrial remodeling would be reflected in the PR interval and P-wave durations on electrocardiogram (ECG). Methods: This cross-sectional analysis of a community-based study included 11,308 men and women age 45–64. Atrial indices were obtained from digital standard 12-lead resting ECG. Analyses were adjusted for traditional cardiovascular risk factors. Results: Both ECG indices displayed a progressive increase across anthropometric indices. Each 5-unit increment in body mass index (BMI) increased P-wave duration by 1.9 ms (95% CI 1.5-2.2) and PR interval by 2.4 ms (95% CI 1.9-3.0), with similar trends for central obesity, even among those without obesity by BMI. Both ECG indices displayed graded increases across levels of blood pressure control, including prehypertension. A joint effect of overweight and hypertension on both ECG indices was detected. P-wave duration or PR interval among people with obesity was not additionally increased by hypertension. Conclusions: P-wave indices increase in general and central obesity. Hypertension exerts an incremental effect in people with overweight but not in people with obesity. The study furthered the understanding of atrial remodeling in the setting of major atrial fibrillation risk factors.