Advanced Interatrial Block is Associated with Recurrence of Atrial Fibrillation Post Pharmacological Cardioversion

Abstract

SUMMARYIntroduction: Management of atrial fibrillation (AF) is hampered by frequent recurrences after restoration of sinus rhythm. Delayed interatrial conduction has been associated with the development of AF in different clinical settings. The aim of our study was to assess whether advanced interatrial block (aIAB) was associated with AF recurrence after pharmacological cardioversion with two different antiarrhythmic drugs. Methods: We included 61 patients with recent onset AF without structural heart disease that underwent successful pharmacological cardioversion. Thirty-one patients received a single oral dose of propafenone, and 30 patients received iv vernakalant. A 12-lead ECG (filter 150 Hz, 25 mm/s, 10 mm/mV) after conversion was evaluated for the presence of interatrial block (IAB); partial (pIAB): P-wave duration > 120 ms, and advanced (aIAB): P-wave > 120 ms and biphasic morphology (AE) in inferior leads. Clinical follow-up and electrocardiographic recordings were performed for a 12-month period. Results: Age was 58 AE 10.4 years and 50.8% were male. aIAB was present in 11 patients (18%) and pIAB in 10 (16.4%). At 1-year follow-up, 22 patients (36%) had AF recurrence. The recurrence rate with aIAB was 90.9% versus 70% in those with pIAB and 12.5% in normal P-wave duration (P = 0.001). The presence of aIAB was strongly associated with AF recurrence (odds ratio 18.4 in multivariable modeling). Recurrence was not affected by the drug used for cardioversion (P = 0.92). Conclusion: Advanced interatrial block is associated with higher risk of AF recurrence at 1 year after pharmacological cardioversion, independent of the drug used.

Bayés’ syndrome: the association between interatrial block and supraventricular arrhythmias

“…A multivariate analysis found IAB to be independently associated with AF recurrence (odds ratio [OR], 18.4). The study confirms that advanced IAB is strongly associated with a higher risk of AF recurrence 1 year following pharmacological cardioversion, independent of the antiarrhythmic drug used [25].…”

Electrocardiographic Advanced Interatrial Block and Atrial Fibrillation Risk in the General Population

“…4–6,14 The higher prevalence in the aforementioned studies likely is due to the populations examined (e.g., those with structural heart disease). In contrast, we observed a lower prevalence in the ARIC study, as this community-based population is not limited to participants with cardiovascular disease.…”

“…4,5 Additionally, aIAB has been associated with a higher risk of AF recurrence after pharmacological cardioversion to normal sinus rhythm. 6 To date, the association between aIAB and AF has not been examined in prospective population-based studies. Therefore, the purpose of this analysis was to examine the prevalence and incidence of aIAB as well as the association between aIAB and AF in the Atherosclerosis Risk In Communities (ARIC) study, a community-based prospective cohort study.…”

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

“…17,18 The delayed and heterogeneous activation of the LA results in dispersion of atrial refractory periods, interatrial dyssynchrony and impaired LA mechanical function, 19,20 all of which favor the development of AF. Thus, IAB (partial or advanced) has been found to be associated with new-onset AF in patients from a general hospital population, 21 , recurrence of AF postelectrical or pharmacological cardioversion, 22,23 , AF recurrence after pulmonary vein isolation, 24 and progression of paroxysmal AF to the persistent or permanent forms of the disease. 25,26 In patients with CHF, the association of Pwave abnormalities with development of AF was first described by Yamada et al 15 using signal averaged ECG (SAECG).…”

“…4 The presence of aIAB is frequently associated with atrial tachyarrhythmias and has been found to be a predictor of AF in different clinical scenarios. [5][6][7] The aim of this study was to determine whether the presence of aIAB is a predictor of new onset AF in patients with advanced CHF undergoing cardiac resynchronization therapy (CRT).…”