QRS Duration Is Associated With Atrial Fibrillation in Patients With Left Ventricular Dysfunction

Background: QRSduration (QRSd) is associated with higher mortality and morbidity in patients with left ventricular (LV) dysfunction. The association between QRSd and atrial fibrillation (AF) has not been studied in this patient population. Objectives: To investigate the association between QRSd and AF in patients with LV dysfunction. Methods: Data were obtained from the National Registry to Advance Heart Health (ADVANCENT) registry, a prospective multicenter registry of patients with left ventricular ejection fraction (LVEF) <= 40%. A total of 25 268 patients from 106 centers in the United States, were enrolled between June 2003 and November 2004. Demographic and clinical characteristics of patients were collected from interviews and medical records. Results: Mean age was 66.3 +/- 13 years, 71.5% were males, and 81.9% were white. A total of 14 452 (57.8%) patients had a QRSd <120 MS, 5304 (21.2%) had a QRSd between 120 and 150 ms, and 5269 (21%) had a QRSd >150 ms. Atrial fibrillation occurred in 20.9%, 27.5%, and 35.5% of patients in the QRS groups, respectively (P < 0.0001.). After adjusting for potential AF risk factors (age, gender, race, body mass index, hypertension, diabetes, renal failure, cancer, lung disease, New York Heart Association [NYHA] class, ejection fraction, etiology of cardiomyopathy) and the use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and lipid lowering drugs, QRS duration remained independently associated with AF (odds ratio: 1.20, 95% confidence interval: 1.14-1.25). Conclusion: In this large cohort of patients, QRSd was strongly associated with AF and therefore may predict the occurrence of this arrhythmia in patients with LV dysfunction. This association persisted after adjusting for disease severity, comorbid conditions, and the use of medications known to be protective against AF.