Advanced interatrial block is an electrocardiographic marker for recurrence of atrial fibrillation after electrical cardioversion

Fujimoto, Yuhi; Yodogawa, Kenji; Maru, Yujin; Oka, Eiichiro; Hayashi, Hiroshi; Yamamoto, Teppei; Iwasaki, Yu‐ki; Hayashi, Meiso; Shimizu, Wataru

doi:10.1016/j.ijcard.2018.07.135

Cited by 25 publications

(23 citation statements)

References 31 publications

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“…First, advanced IAB is likely a presentation of AP‐independent atrial electrophysiological abnormalities that remain after successful AP ablation. In support of this, advanced IAB was previously reported to reflect the underlying atrial substrate with atrial fibrosis and to be associated with the development of AF . Second, advanced IAB may play a role in initiating and maintaining reentry circuits by promoting the occurrence of unidirectional block, an important mechanism in the development of AF.…”

Section: Discussionmentioning

confidence: 66%

“…In support of this, advanced IAB was previously reported to reflect the underlying atrial substrate with atrial fibrosis 27,28 and to be associated with the development of AF. [12][13][14][15][16][17][18][19][20] Second, advanced IAB may play a role in initiating and maintaining reentry circuits by promoting the occurrence of unidirectional block, 29 an important mechanism in the development of Multiple APs, n (%) 5 (4.9%) 0 (0.0%) 5 (5.4%) 1.00…”

Section: Discussionmentioning

confidence: 99%

“…10 The appearance of advanced IAB is frequently associated with atrial tachyarrhythmias, and has been found to predict AF in multiple clinical scenarios. [12][13][14][15][16][17][18][19][20] However, the role of advanced IAB in predicting the recurrence of AF after AP ablation in patients with WPW syndrome is unclear. Thus, in the present study, we investigated the clinical utility of advanced IAB for predicting the risk of AF recurrence in patients with verified paroxysmal AF and WPW syndrome after successful AP ablation.…”

Section: Paroxysmal Atrial Fibrillation (Af) Occurs Frequently In Patmentioning

confidence: 99%

“…A prolonged P‐wave with biphasic (±) morphology in the inferior leads represents an even higher degree of IAB and has been referred to as advanced IAB . The appearance of advanced IAB is frequently associated with atrial tachyarrhythmias, and has been found to predict AF in multiple clinical scenarios . However, the role of advanced IAB in predicting the recurrence of AF after AP ablation in patients with WPW syndrome is unclear.…”

Section: Introductionmentioning

confidence: 99%

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Advanced interatrial block predicts recurrence of atrial fibrillation after accessory pathway ablation in patients with Wolff‐Parkinson‐White syndrome

Zhao

et al. 2019

Clinical Cardiology

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Background Paroxysmal atrial fibrillation (AF) frequently occurs in patients with Wolff‐Parkinson‐White (WPW) syndrome. Although successful ablation of the accessory pathway (AP) eliminates paroxysmal AF in some patients, in other patients it can recur. Hypothesis We investigated the clinical utility of advanced interatrial block (IAB) for predicting the risk of AF recurrence in patients with verified paroxysmal AF and WPW syndrome after successful AP ablation. Methods This retrospective study included 103 patients (70 men, 33 women; mean age, 44 ± 16 years) with WPW syndrome who had paroxysmal AF. A resting 12‐lead electrocardiogram was performed immediately after successful AP ablation to evaluate the presence of advanced IAB, which was defined as a P‐wave duration of >120 ms and biphasic [±] morphology in the inferior leads. Results During the mean follow‐up period of 30.9 ± 20.0 months (range, 2‐71 months), 16 patients (15.5%) developed AF recurrence. Patients with advanced IAB had significantly reduced event‐free survival from AF ( P < .001). Cox regression analysis with adjustment for the left atrial diameter and CHA 2 DS 2 ‐VASc score identified advanced IAB (hazard ratio, 9.18; 95% confidence interval [CI], 2.30‐36.72; P = .002) and age > 50 years (hazard ratio, 12.64; 95% CI, 1.33‐119.75; P = .027) as independent predictors of AF recurrence. Conclusions Advanced IAB was an independent predictor of AF recurrence after successful AP ablation in patients with WPW syndrome.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Paroxysmal Atrial Fibrillation (Af) Occurs Frequently In Patmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Advanced interatrial block predicts recurrence of atrial fibrillation after accessory pathway ablation in patients with Wolff‐Parkinson‐White syndrome

Zhao

et al. 2019

Clinical Cardiology

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“…Thus, about 20–30% of patients relapse to AF within one month, 40–60% within three months, and 60–80% in less than a year [ 15 , 17 , 18 ]. Within this context, identification of patients with an increased risk of early AF recurrence is important for a rational clinical therapeutic strategy [ 19 ]. Thus, the procedure could be avoided on those patients with high chance of early failure due to their proarrhythmic condition, saving healthcare costs and preventing them from associated risks and side effects.…”

Section: Introductionmentioning

confidence: 99%

Multi-scale Entropy Evaluates the Proarrhythmic Condition of Persistent Atrial Fibrillation Patients Predicting Early Failure of Electrical Cardioversion

Cirugeda-Roldán

Calero

Manuel

et al. 2020

Entropy

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Atrial fibrillation (AF) is nowadays the most common cardiac arrhythmia, being associated with an increase in cardiovascular mortality and morbidity. When AF lasts for more than seven days, it is classified as persistent AF and external interventions are required for its termination. A well-established alternative for that purpose is electrical cardioversion (ECV). While ECV is able to initially restore sinus rhythm (SR) in more than 90% of patients, rates of AF recurrence as high as 20–30% have been found after only a few weeks of follow-up. Hence, new methods for evaluating the proarrhythmic condition of a patient before the intervention can serve as efficient predictors about the high risk of early failure of ECV, thus facilitating optimal management of AF patients. Among the wide variety of predictors that have been proposed to date, those based on estimating organization of the fibrillatory (f-) waves from the surface electrocardiogram (ECG) have reported very promising results. However, the existing methods are based on traditional entropy measures, which only assess a single time scale and often are unable to fully characterize the dynamics generated by highly complex systems, such as the heart during AF. The present work then explores whether a multi-scale entropy (MSE) analysis of the f-waves may provide early prediction of AF recurrence after ECV. In addition to the common MSE, two improved versions have also been analyzed, composite MSE (CMSE) and refined MSE (RMSE). When analyzing 70 patients under ECV, of which 31 maintained SR and 39 relapsed to AF after a four week follow-up, the three methods provided similar performance. However, RMSE reported a slightly better discriminant ability of 86%, thus improving the other multi-scale-based outcomes by 3–9% and other previously proposed predictors of ECV by 15–30%. This outcome suggests that investigation of dynamics at large time scales yields novel insights about the underlying complex processes generating f-waves, which could provide individual proarrhythmic condition estimation, thus improving preoperative predictions of ECV early failure.

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P-wave duration as a marker of atrial remodeling in patients referred to ablation for atrial fibrillation: A new stratification tool emerging?

Koutalas

Kallergis

Nedios

et al. 2023

Hellenic Journal of Cardiology

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Advanced interatrial block is an electrocardiographic marker for recurrence of atrial fibrillation after electrical cardioversion

Cited by 25 publications

References 31 publications

Advanced interatrial block predicts recurrence of atrial fibrillation after accessory pathway ablation in patients with Wolff‐Parkinson‐White syndrome

Advanced interatrial block predicts recurrence of atrial fibrillation after accessory pathway ablation in patients with Wolff‐Parkinson‐White syndrome

Multi-scale Entropy Evaluates the Proarrhythmic Condition of Persistent Atrial Fibrillation Patients Predicting Early Failure of Electrical Cardioversion

P-wave duration as a marker of atrial remodeling in patients referred to ablation for atrial fibrillation: A new stratification tool emerging?

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