Prevalence of Interatrial Block in the Program of All‐Inclusive Care for the Elderly (PACE)

Abstract

Interatrial block (IAB) (P wave > or =110 milliseconds) is a potent correlate of atrial tachyarrhythmias, left atrial electromechanical dysfunction, and embolism. IAB has been demonstrated to be highly prevalent in the general hospital population, but no investigation has addressed this in the elderly community outside the hospital. We appraised the prevalence of IAB in a service of the Program of All-Inclusive Care for the Elderly (PACE), the Elder Service Plan (ESP). Of the 202 ESP members in Worcester, MA, 167 (ages 61-103 years; female 81.4%) who had current 12-lead electrocardiograms were evaluated for IAB, and an age-based comparison was made between those with and without IAB. Of those patients with current electrocardiograms, 148 (88.6%) showed sinus rhythm and 72 (48.6%) depicted IAB: 20% in patients aged 60-69 years, 39.5% aged 70-79 years, 56.8% aged 80-89 years, and 50% in those 90 years and older. Given its sequelae of anatomic and pathophysiologic consequences, prompt recognition of IAB in a high-risk group such as that in the PACE community (48.6% prevalence) is important, especially for anticipation of atrial fibrillation and possible embolism.

Potential Factors That Affect Electrocardiographic Progression of Interatrial Block

“…The prevalence of aIAB in the general population is estimated to be ≤2% while in geriatric populations, this prevalence rises to approximately 6% 11 . As such, aIAB is seemingly greatly overshadowed by its pIAB counterpart that is prevalent at almost pandemic proportions: >40% in two separate yet comparable general hospital populations 1 .…”

Prevalence and predictors of subclinical atrial fibrillation in hospitalized older adults

“…Interatrial block (IAB) is a conduction delay between the atria, detectable on the ECG. Its prevalence increases with age and has been found to be associated with an increased risk of AF [ 52 ]. In agreement with previous studies, we found higher prevalence of SCAF in patients with IAB in our study, although without reaching the statistical significance, likely due to the small sample size [ 53 ].…”

Bloqueo interauricular avanzado en pacientes con hipertensión arterial sistémica y fibrilación auricular

“…Varios estudios realizados sobre el BIA han reportado una alta prevalencia de este bloqueo interauricular en entornos hospitalarios y ambulatorios, lo que llevó a algunos autores a referirse a este hallazgo electrocardiográfico como una pandemia infradiagnosticada (27)(28)(29)(30)(31) . De hecho, en un estudio que utilizó 1000 ECG no seleccionados, consecutivos, en pacientes hospitalizados, observó la presencia del BIA en el 47% de los pacientes que tenían ritmo sinusal normal (28) .…”

“…En el ámbito ambulatorio, un estudio realizado en la población general de una comunidad de ancianos mayores de 65 años reveló que la prevalencia de BIA fue del 59%,con una correlación significativa entre con la hipertensión arterial sistémica (29) . En otro estudio realizado sobre una población de la comunidad de ancianos de un programa de atención integral para personas mayores se encontró una prevalencia de BIA de 48,6% (30) . Es evidente que el BIA es un hallazgo electrocardiográfico bastante frecuente, por ende, es importante buscarlo e identificarlo sobre todo en personas mayores.…”

“…La disfunción electromecánica de la aurícula izquierda (AI) desarrolla ciertos trastornos como activación anormal de la AI, aumento presión de la AI, dilatación de la AI, disfunción endotelial, y fibrosis auricular. Estas alteraciones fisiopatológicas favorecen el desarrollo de la FA con sus complicaciones tromboembólicas (27)(28)(29)(30) . El BIA avanzado (Figura 1) ocurre secundariamente a la conducción auricular interrumpida o enlentecida, lo que puede conducir a cambios en períodos refractarios auriculares y la aparición de latidos auriculares prematuros, desencadenantes de arritmias auriculares (22)(23)(24)(25)(26) .…”