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. 2020;145(11):720-729.
doi: 10.1159/000509916. Epub 2020 Oct 6.

Interatrial Block Predicts Atrial Fibrillation and Total Mortality in Patients with Cardiac Resynchronization Therapy

Jonatan Jacobsson  1   2 , Jonas Carlson  3 , Christian Reitan  3   4 , Rasmus Borgquist  3   5 , Pyotr G Platonov  3
Affiliations

Interatrial Block Predicts Atrial Fibrillation and Total Mortality in Patients with Cardiac Resynchronization Therapy

Jonatan Jacobsson et al. Cardiology. 2020.

Abstract

Background: Interatrial block (IAB) and abnormal P-wave terminal force in lead V1 (PTFV1) are electrocardiographic (ECG) abnormalities that have been shown to be associated with new-onset atrial fibrillation (AF) and death. However, their prognostic importance has not been proven in cardiac resynchronization therapy (CRT) recipients.

Objective: To assess if IAB and abnormal PTFV1 are associated with new-onset AF or death in CRT recipients.

Methods: CRT recipients with sinus rhythm ECG at CRT implantation and no AF history were included (n = 210). Automated analysis of P-wave duration (PWD) and morphology classified patients as having either no IAB (PWD <120 ms), partial IAB (pIAB: PWD ≥120 ms, positive P waves in leads II and aVF), or advanced IAB (aIAB: PWD ≥120 ms and biphasic or negative P wave in leads II or aVF). PTFV1 >0.04 mm•s was considered abnormal. Adjusted Cox regression analyses were performed to assess the impact of IAB and abnormal PTFV1 on the primary endpoint new-onset AF, death, or heart transplant (HTx) and the secondary endpoint death or HTx at 5 years of follow-up.

Results: IAB was found in 45% of all patients and independently predicted the primary endpoint with HR 1.9 (95% CI 1.2-2.9, p = 0.004) and the secondary endpoint with HR 2.1 (95% CI 1.2-3.4, p = 0.006). Abnormal PTFV1 was not associated with the endpoints.

Conclusions: IAB is associated with new-onset AF and death in CRT recipients and may be helpful in the risk stratification in the context of heart failure management. Abnormal PTFV1 did not demonstrate any prognostic value.

Keywords: Abnormal P-wave terminal force in lead V1; Atrial fibrillation; Cardiac resynchronization therapy; Heart failure; Interatrial block; Mortality; Risk stratification.

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Conflict of interest statement

R.B. received lecture fees from Medtronic and Abbot. The other authors declare that they have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Illustration of the IAB groups.
Fig. 2
Fig. 2
Illustration of abnormal PTFV1
Fig. 3
Fig. 3
Kaplan-Meier plot comparing patients with no IAB to patients with IAB. Endpoint: new-onset AF, death, or heart transplant. log-rank p = 0.004.
Fig. 4
Fig. 4
Kaplan-Meier plot comparing patients with no IAB, to patients with either pIAB or aIAB. Endpoint: new-onset AF, death, or heart transplant. log-rank p = 0.013.
Fig. 5
Fig. 5
Kaplan-Meier plot comparing patients with normal PTFV1 to patients with abnormal PTFV1. Endpoint: new-onset AF, death, or heart transplant. log-rank p = 0.869.
Fig. 6
Fig. 6
Forest plot of the adjusted multivariate analysis found in Table 3.
See this image and copyright information in PMC

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