Incidence rates, correlates, and prognosis of electrocardiographic P-wave abnormalities – a nationwide population-based study

Scant data exist on incidence rates, correlates, and prognosis of electrocardiographic P-wave abnormalities in the general population. We recorded ECG and measured conventional cardiovascular risk factors in 5667 Finns who were followed up for incident atrial fibrillation (AF). We obtained repeat ECGs from 3089 individuals 11years later. The incidence rates of prolonged P-wave duration, abnormal P terminal force (PTF), left P-wave axis deviation, and right P-wave axis deviation were 16.0%, 7.4%, 3.4%, and 2.2%, respectively. Older age and higher BMI were associated with incident prolonged P-wave duration and abnormal PTF (P≤0.01). Higher blood pressure was associated with incident prolonged P-wave duration and right P-wave axis deviation (P≤0.01). During follow-up, only prolonged P-wave duration predicted AF (multivariable-adjusted hazard ratio, 1.38; P=0.001). Modifiable risk factors associate with P-wave abnormalities that are common and may represent intermediate steps of atrial cardiomyopathy on a pathway leading to AF. •Electrocardiographic P-wave abnormalities occur commonly in the population.•Increasing age, BMI, and blood pressure associate with incident P-wave abnormalities.•Prolonged P-wave duration is related to a 1.38-fold risk of atrial fibrillation (AF).•P-wave abnormalities may intermediate relation between modifiable risk factors and AF.