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. 2022 Jun 16:13:913454.
doi: 10.3389/fphys.2022.913454. eCollection 2022.

Advanced Interatrial Block Predicts Recurrence of Atrial Fibrillation and Ischemic Stroke in Elderly Patients With Hypertension

Haijun Wang  1 , Lili Cai  2 , Yan Guo  1 , Li Shuai  1 , Yang Shi  1 , Quanjin Si  3
Affiliations

Advanced Interatrial Block Predicts Recurrence of Atrial Fibrillation and Ischemic Stroke in Elderly Patients With Hypertension

Haijun Wang et al. Front Physiol. .

Abstract

Background: This study aimed to investigate whether advanced interatrial block (IAB) is a predictor of recurrent atrial fibrillation (AF) and/or ischemic stroke in elderly patients with AF and hypertension. Methods and objectives: Five hundred and sixteen elderly inpatients (mean age 85.53 ± 9.08 years; 5.43% women) with concurrent paroxysmal AF and hypertension were enrolled in this retrospective observational study. Data on comorbidity, medication, digital electrocardiograms (ECG), and outcomes were obtained from the medical records and follow-up examinations. IAB was classified as partial IAB or advanced IAB according to 12-lead surface ECG analysis on admission. Advanced IAB was defined as a maximum P wave duration of >120 ms with biphasic (±) morphology in leads II, Ⅲ, and aVF by two blinded investigators. The endpoints were recurrent AF and ischemic stroke. Results: We enrolled 120 patients (23.26%) with partial IAB and 187 (36.24%) with advanced IAB. The mean follow-up duration was 19 months. A total of 320 patients (62.02%) developed AF recurrence, and 31 (6.01%) experienced ischemic stroke. Significant predictors of advanced IAB in multivariate analysis were older age (>80 years), increased left atrial diameter (>40 mm), and being overweight (body mass index >25 kg/m2). In the multivariable comprehensive Cox regression analyses, partial IAB was associated with AF recurrence. Advanced IAB was an independent predictor of increased risk of AF recurrence and ischemic stroke. Conclusion: Both partial and advanced IAB are associated with AF recurrence in elderly patients with hypertension. Furthermore, advanced IAB is an independent predictor of ischemic stroke.

Keywords: atrial fibrillation; elderly; hypertension; interatrial block; stroke.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Interatrial block (IAB) degree. (A) partial IAB:P wave ≥120 ms without bimodal morphology;(B) advanced IAB:P wave ≥120 ms with bimodal morphology in inferior leads.
FIGURE 2
FIGURE 2
Kalpana-Meier estimate of cumulative incidences of (A) recurrent atrial fibrillation and (B) ischemic stroke according to the interatrial block (IAB) degree.
See this image and copyright information in PMC

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