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

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.

P‐wave durations from automated electrocardiogram analysis to predict atrial fibrillation and mortality in heart failure

“… 31 A study of HF patients receiving cardiac resynchronization therapy devices found that abnormal P‐wave terminal force in V1 and PWD ≥ 120 ms significantly predicted new‐onset AF and all‐cause mortality. 32 Moreover, prolongations in amplified PWDs were predictive of new‐onset AF in patients with HF with preserved ejection fraction. 33 Similar findings have been observed in the context of HF with reduced ejection fraction.…”

“…By contrast, prolonged PWDs ≥120 ms predicted new‐onset AF and all‐cause mortality, whereas abnormal P‐wave terminal force in V1 predicted stroke 31 . A study of HF patients receiving cardiac resynchronization therapy devices found that abnormal P‐wave terminal force in V1 and PWD ≥ 120 ms significantly predicted new‐onset AF and all‐cause mortality 32 . Moreover, prolongations in amplified PWDs were predictive of new‐onset AF in patients with HF with preserved ejection fraction 33 .…”

Electrocardiographic markers of atrial cardiomyopathy and risk of heart failure in the multi-ethnic study of atherosclerosis (MESA) cohort

“…We also observed an association between aIAB and incident HF in our study. aIAB is a risk factor for AF, stroke, cognitive impairment, and mortality ( 40 – 42 ). Advanced age, hypertension, and coronary artery disease (CAD) are risk factors for aIAB development and are pathophysiologically linked to fibrotic atrial cardiomyopathy (FAC) and reduced LA strain indexes ( 42 , 43 ).…”

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

“…Some previous studies demonstrated that advanced IAB was associated with CHADS 2 score, which was also a common independent predictor of IAB development and ischemic stroke ( Wu et al, 2018 ). Furthermore, a recent study demonstrated that advanced IAB could predict all-cause mortality in ischemic stroke survivors with and without additional cardiovascular comorbidities ( Baturova et al, 2019 ; Jacobsson et al, 2020 ; Prasitlumkum et al, 2020 ).…”