Older Patients with Elevated Pre-sepsis PTFV1 Demonstrate Greater Occurrence of Atrial Fibrillation and Worse In-Hospital Outcomes

Background: Elevated P-wave terminal force in lead V1 (PTFV1) >5000 μV*ms is a predictor of atrial fibrillation and stroke in a general population. The risk for atrial fibrillation and ischemic stroke is high in sepsis but predictors are lacking. Objectives: Analysis of a prospective, observational cohort study with subjects categorized by PTFV1 (lower and higher than 5000 μV*ms) cutoffs and by age (older and younger than 60 years old). Methods: Of the 360 consented sepsis patients, 273 had evaluable pre-sepsis electrocardiograms (ECG). PTFV1 was measured by 3 independent and blinded assessors using the Mitutoyo 500-195-30CAL Absolute Digimatic Caliper on the last available ECG before sepsis onset. Patient characteristics and outcomes were compared between lower (PTFV1 < 5,000 μV*ms) and higher PTFV1 (PTFV1 > 5,000 μV*ms), and older and younger patients with elevated pre-sepsis PTFV1. Results: The median age was 63 years [IQR 53, 71], 44% women. Median of the last ECG prior to sepsis-onset was 1 day [IQR, 0, 9]. 32% of individuals had pre-sepsis PTFV1 > 5,000 μV*ms, and were mostly females. Older patients with PTFV1 > 5,000 μV*ms had greater pre-sepsis left atrial diameter, more in-hospital new-onset atrial fibrillation, greater Charlson Comorbidity Index score, and worse clinical trajectory, compared to younger patients with PTFV1 > 5,000 μV*ms. Conclusions: Older individuals with elevated pre-sepsis PTFV1 had greater occurrence of AF and worse outcomes during sepsis. Future studies will test pre-sepsis PTFV1 as a predictor of in-hospital and longitudinal outcomes in older sepsis patients at risk of atrial fibrillation, stroke and frailty.