Interatrial block as a predictor of atrial fibrillation in patients with ST‐segment elevation myocardial infarction

Çinier, Göksel; Tekkeşin, Ahmet İlker; Genç, Duygu; Yıldız, Ufuk; Parsova, Kemal Emrecan; Pay, Levent; Alexander, Bryce; Bozbeyoğlu, Emrah; Türkkan, Ceyhan; Alper, Ahmet Taha; Baranchuk, Adrián

doi:10.1002/clc.23029

Cited by 15 publications

(4 citation statements)

References 27 publications

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“…Çinier et al 15 proposed IABs are prevalent in patients with STEMI and associated with the presence of diffuse coronary artery disease and new onset of AF. In our study, we focused on the presence of preoperative and postoperative (sixth month) IABs, their grades, and their associations with TAVIrelated factors among older adults with TAVI procedure.…”

Section: Discussionmentioning

confidence: 99%

Interatrial blocks in patients with tavi and their associations with clinic parameters

Alıç¹,

Yetişen²,

Savcılıoğlu³

et al. 2023

JCCVS

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Aims: The present study attempted to evaluate the prevalence of basal interatrial blocks (IABs), their associations with clinical parameters, and the interatrial conduction in the follow-up after a successful transcatheter aortic valve implantation (TAVI) procedure among patients with severe aortic stenosis. Methods: We retrospectively evaluated the findings of 90 patients undergoing TAVI in our center. Overall, we considered the presence and grades of IABs and P-wave durations in electrocardiograms (ECG), preoperative echocardiography (ECHO) findings (maximum and mean gradients and left atrium (LA) diameter), valve size and type, and changes in these parameters at sixth month. Results: Forty-six patients were included in the study which are suitable for the pre-determined inclusion criteria. We found the mean age of the patients to be 74.78 ± 8.66 years. In preoperatively-evaluated ECGs, while we detected partial IABs in 37% of the patients, there were advanced IABs in 6.5%, but 56.5% yielded no interatrial conduction disorder. On the other hand, in postoperatively-evaluated ECGs, while we observed partial IABs in 30.4% of the patients, there were advanced IABs among 21.7% (p = 0.017). Nevertheless, we could not conclude any IABs among 47.8% of the patients. Besides, 54.3% of the patients received a self-expandable valve, and a balloon-expandable valve was inserted in 45.7%. In this regard, we detected partial (7 patients) and advanced (2 patients) IABs in the preoperatively-evaluated ECGs of the patients receiving a self-expandable valve. In the postoperative ECGs of these patients, while the partial IAB remained the same in 4 patients (57.1%), it progressed to an advanced IAB in 3 (42.9%). In addition, while the advanced IAB regressed to a partial IAB in one patient, it remained the same for the other patient. In this group, the mean P-wave durations were found to be 118.4±22.67 before the TAVI and 119.6±21.69 after the TAVI (p = 0.113). In the preoperative ECGs of 21 patients with a balloon-expandable valve, we detected partial IABs in 10 patients and an advanced IAB in one patient. While a partial IAB developed in five patients (p = 0.022), five patients with a partial IAB developed an advanced IAB following the procedure (p = 0.022). In this group, we noticed a significant difference between preoperative (127.62±19.4) and postoperative (138.71+ 32.03) P-wave durations (p = 0.038). Conclusion: In a nutshell, we concluded no significant change in interatrial conduction time of the patients with TAVI compared to the baseline in their sixth-month ECGs. When considered by valve type, we concluded that the development and progression of IABs were significant among those with a balloon-expandable valve. The higher postoperative mean gradient among those with a balloon-expandable valve compared to those with a self-expandable valve may be associated with significantly longer P-wave duration among those with a balloon-expandable valve.

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Section: Discussionmentioning

confidence: 99%

Interatrial blocks in patients with tavi and their associations with clinic parameters

Alıç¹,

Yetişen²,

Savcılıoğlu³

et al. 2023

JCCVS

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“…P-wave duration ≥120 ms with normal P-wave morphology is defined as partial IAB. In STEMI patients (n=198) without a history of atrial arrhythmias treated successfully with primary percutaneous coronary intervention (PCI), about half of the patients had partial or advanced IAB at presentation, while six hours after PCI, the prevalence of IAB had decreased to one quarter [8]. RCA stenosis and diffuse coronary artery disease were associated with IAB at admission.…”

Section: Interatrial Blockmentioning

confidence: 99%

Conduction Disorders in the Setting of Acute STEMI

Nikus

Birnbaum

Fiol‐Sala

et al. 2021

CCR

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: ST-elevation myocardial (STEMI) is frequently associated with conduction disorders. Regional myocardial ischemia or injury may affect the cardiac conduction system at various locations, and neural reflexes or changes in the balance of the autonomous nervous system may be involved. Sinoatrial and atrioventricular block are more frequent in inferior than anterior STEMI, while new left anterior fascicular block and right bundle branch block indicate proximal occlusion of the left anterior descending coronary artery. New left bundle branch block is associated with multi-vessel disease. Most conduction disorders associated with STEMI are reversible with reperfusion therapy, but they may still impair prognosis, because they indicate a large area at risk, extensive myocardial infarction or severe coronary artery disease. Acute STEMI recognition is possible in patients with fascicular or right bundle branch block, but future studies need to define the cut-off values for ST depression in the leads V1-V3 in inferolateral MI and for ST elevation in the same leads in anterior STEMI. In left bundle branch block, concordant ST elevation is a specific sign of acute coronary artery occlusion, but the ECG feature has low sensitivity.

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“…Interatrial block (IAB) denotes a conduction delay between the right and left atria that manifests in a 12-lead electrocardiogram (ECG) as a P-wave duration of >120 ms. 10,11 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. 10 The appearance of advanced IAB is frequently associated with atrial tachyarrhythmias, and has been found to predict AF in multiple clinical scenarios.…”

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

confidence: 99%

“…Interatrial block (IAB) denotes a conduction delay between the right and left atria that manifests in a 12‐lead electrocardiogram (ECG) as a P‐wave duration of >120 ms . 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 .…”

Section: Introductionmentioning

confidence: 99%

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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Interatrial block as a predictor of atrial fibrillation in patients with ST‐segment elevation myocardial infarction

Abstract: IAB is common in patients with STEMI and along with the presence of diffuse coronary artery disease is associated with new onset of AF.

Cited by 15 publications

References 27 publications

Interatrial blocks in patients with tavi and their associations with clinic parameters

Interatrial blocks in patients with tavi and their associations with clinic parameters

Conduction Disorders in the Setting of Acute STEMI

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

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