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The association of the QT interval with atrial fibrillation and stroke: the Multi-Ethnic Study of Atherosclerosis



Prolongation of the QT interval is associated with an increased risk of atrial fibri llation (AF) and stroke.


The purpose of this analysis was to determine if AF explains the association between prolonged QT and stroke.


A total of 6305 participants (mean age 62 ± 10 years; 54 % women; 38 % whites; 27 % blacks; 23 % Hispanics; 12 % Chinese–Americans) from the Multi-Ethnic Study of Atherosclerosis (MESA) were included in this analysis. A linear scale was used to compute heart rate-adjusted QT (QTa). Prolonged QTa was defined as ≥460 ms in women and ≥450 ms in men. Incident AF cases were identified using hospital discharge records and Medicare claims data. Vascular neurologists adjudicated stroke events by medical record review. Cox regression was used to examine the association between prolonged QTa and stroke with and without AF.


A total of 216 (3.4 %) of study participants had prolonged QTa. Over a median follow-up of 8.5 years, 280 (4.4 %) participants developed AF and 128 (2.0 %) participants developed stroke. In a multivariable Cox regression analysis adjusted for socio-demographics, cardiovascular risk factors, and potential confounders, prolonged QTa was associated with an increased risk of AF (HR = 1.7, 95 % CI 1.1, 2.6) and stroke (HR = 2.3, 95 % CI 1.3, 4.1). When AF was included as a time-dependent covariate, the association between prolonged QTa and stroke was not substantively altered (HR = 2.4, 95 % CI 1.3, 4.3).


The increased risk of stroke in those with prolonged QT potentially is not explained by documented AF. Further research is needed to determine if subclinical AF explains the association between the QT interval and stroke.

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The authors thank the other investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at This research was supported by contracts N01-HC-95159 through N01-HC-95169 from the National Heart, Lung, and Blood Institute and by grants UL1-RR-024156 and UL1-RR-025005 from NCRR.

Conflict of interest

Dr. Nazarian is a consultant and principal investigator for research funding awarded to Johns Hopkins University from Biosense Webster Inc.

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Correspondence to Wesley T. O’Neal.

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O’Neal, W.T., Efird, J.T., Kamel, H. et al. The association of the QT interval with atrial fibrillation and stroke: the Multi-Ethnic Study of Atherosclerosis. Clin Res Cardiol 104, 743–750 (2015).

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  • Atrial fibrillation
  • Stroke
  • Long QT