Advanced interatrial block and P-wave duration are associated with atrial fibrillation and stroke in older adults with heart disease: the BAYES registry

Abstract

Aims: Advanced interatrial block (IAB), is an unrecognized surrogate of atrial dysfunction and a trigger of atrial dysrhythmias, mainly atrial fibrillation (AF). Our aim was to prospectively assess whether advanced IAB in sinus rhythm is associated with AF and stroke in elderly outpatients with structural heart disease, a group not previously studied.

Methods and results: Prospective observational registry that included outpatients aged ≥70 years with structural heart disease and no previous diagnosis of AF. Patients were divided into three groups: normal P-wave duration (<120 ms), partial IAB (P-wave duration ≥120 ms, positive in the inferior leads), and advanced IAB [P-wave duration ≥120 ms, biphasic (plus/minus) morphology in the inferior leads]. Among 556 individuals, 223 had normal P-wave (40.1%), 196 partial IAB (35.3%), and 137 advanced IAB (24.6%). After a median follow-up of 694 days, 93 patients (16.7%) developed AF, 30 stroke (5.4%), and 34 died (6.1%). Advanced IAB was independently associated with AF -[hazard ratio (HR) 2.9, 95% confidence interval (CI) 1.7-5.1; P < 0.001], stroke [HR 3.8, 95% CI 1.4-10.7; P = 0.010), and AF/stroke (HR 2.6, 95% CI 1.5-4.4; P = 0.001). P-wave duration (ms) was independently associated with AF (HR 1.05, 95% CI 1.03-1.07; P < 0.001), AF/stroke (HR 1.04, 95% CI 1.02-1.06; P < 0.001), and mortality (HR 1.04, 95% CI 1.00-1.08; P = 0.021).

Conclusions: The presence of advanced IAB in sinus rhythm is independently associated with AF and stroke in an elderly population with structural heart disease and no previous diagnosis of AF. P-wave duration was also associated with all-cause mortality.

Keywords: Atrial fibrillation; Bayés syndrome; Interatrial block; Mortality; P-wave duration; Stroke.