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. 2015 Nov;20(6):586-91.
doi: 10.1111/anec.12258. Epub 2015 Feb 2.

Advanced Interatrial Block Predicts New Onset Atrial Fibrillation in Patients with Severe Heart Failure and Cardiac Resynchronization Therapy

Fariha Sadiq Ali  1 , Andres Enriquez  1 , Diego Conde  2 , Damian Redfearn  1 , Kevin Michael  1 , Christopher Simpson  1 , Hoshiar Abdollah  1 , Antoni Bayés de Luna  1   3 , Wilma Hopman  1 , Adrian Baranchuk  1
Affiliations

Advanced Interatrial Block Predicts New Onset Atrial Fibrillation in Patients with Severe Heart Failure and Cardiac Resynchronization Therapy

Fariha Sadiq Ali et al. Ann Noninvasive Electrocardiol. 2015 Nov.

Abstract

Background: Advanced interatrial block (aIAB) on the surface electrocardiogram (ECG), defined as a P-wave duration ≥120 milliseconds with biphasic (±) morphology in inferior leads, is frequently associated with atrial fibrillation (AF). The aim of this study was to determine whether preoperative aIAB could predict new-onset AF in patients with severe congestive heart failure (CHF) requiring cardiac resynchronization therapy (CRT).

Methods: Retrospective analysis of consecutive patients with CHF and no prior history of AF undergoing CRT for standard indications. A baseline 12-lead ECG was obtained prior to device implantation and analyzed for the presence of aIAB. ECGs were scanned at 300 DPI and maximized 8×. Semiautomatic calipers were used to determine P-wave onset and offset. The primary outcome was the occurrence of AF identified through analyses of intracardiac electrograms on routine device follow-up.

Results: Ninety-seven patients were included (74.2% male, left atrial diameter 45.5 ± 7.8 mm, 63% ischemic). Mean P-wave duration was 138.5 ± 18.5 milliseconds and 37 patients (38%) presented aIAB at baseline. Over a mean follow-up of 32 ± 18 months, AF was detected in 29 patients (30%) and the incidence was greater in patients with aIAB compared to those without it (62% vs 28%; P < 0.003). aIAB remained a significant predictor of AF occurrence after multivariate analysis (OR 4.1; 95% CI, 1.6-10.7; P < 0.003).

Conclusion: The presence of aIAB is an independent predictor of new-onset AF in patients with severe CHF undergoing CRT.

Keywords: atrial fibrillation; cardiac resynchronization; heart failure; interatrial block.

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Figures

Figure 1
Figure 1
(A) Typical ECG of aIAB with P‐wave duration >120 milliseconds and biphasic morphology in inferior leads (see arrow). (B) Diagram of atrial conduction showing block of the electrical impulse in the upper and middle part of the interatrial septum and retrograde LA activation via muscular connections in the vicinity of coronary sinus (modified from Yamada et al.15).
See this image and copyright information in PMC

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