Usefulness of a Combination of Interatrial Block and a High CHADS₂ Score to Predict New Onset Atrial Fibrillation

Abstract

SummaryInteratrial block (IAB) is associated with an increased risk of atrial fibrillation (AF). The aim of this retrospective study was to investigate the association of a combination of IAB and the CHADS 2 score, an AF-related risk score for ischemic stroke, with new onset AF in patients in sinus rhythm. A total of 1,571 patients (803 males, 768 females; mean age: 58 ± 16 years) were included in this study. IAB was defined as a P-wave duration > 120 ms in the 12-lead electrocardiogram, and a high CHADS 2 score as ≥ 2 points. During the mean follow-up period of 4.8 ± 0.7 years, new onset AF occurred in 122 patients (16.1 per 1,000 patient-years). The incidence of new onset AF was 4.0 per 1,000 patient-years in patients with no IAB and a low CHADS 2 score, and 44.0 per 1,000 patient-years in patients with IAB and a high CHADS 2 score. In multivariate Cox regression analysis, the hazard ratio for IAB and a high CHADS 2 score compared with no IAB and a low CHADS 2 score was 12.18 (95% confidence interval: 6.22-23.87, P < 0.001), after adjustment for age, sex, coronary artery disease, valvular heart disease, smoking, medications, and echocardiographic parameters. In conclusion, IAB and a high CHADS 2 score independently and synergistically predict new onset AF in patients in sinus rhythm, indicating an approximately 12-fold higher risk in patients with both IAB and a high CHADS 2 score. Patients meeting these criteria should have more aggressive early intervention to prevent AF. (Int Heart J 2016; 57: 580-585) Key words: Electrocardiogram, Prognosis A trial fibrillation (AF) is a common cardiac arrhythmia in the general population 1) and is associated with an increased risk of death, hospitalization, stroke, and heart failure.2-5) Therefore, it is crucial to identify patients who are at increased risk of developing new onset AF. Interatrial block (IAB) is manifested in the 12-lead electrocardiogram (ECG) by a P-wave duration > 120 ms, 6) and has been associated with increased risk of AF.7-11) Currently, the CHADS 2 score is widely used for predicting future ischemic stroke in patients with AF. 12) Although AF is more prevalent in subjects with high CHADS 2 scores than in those with low CHADS 2 scores, 13,14) the combined role of IAB and the CHADS 2 score in new onset AF in patients in sinus rhythm remains unclear. Therefore, in the present study, we investigated the association of a combination of IAB and high CHADS 2 score on new onset AF in patients in sinus rhythm. MethodsStudy population: Our database of ECG recordings of patients who were hospitalized in Henan Provincial People's Hospital for any therapy between March 1, 2010 and March 15, 2010 was retrospectively reviewed. If patients had more than one ECG recording during the index hospitalization, only the first recording was analyzed to measure P-wave duration, and all of the ECG recordings were analyzed to detect AF. Pwave duration was measured using a resting 12-lead ECG (high-pass filter 0.05 Hz, low-pass filter 150 Hz, 25 mm/s, 10 mm/mv) in all pati...

Association Between CHADS₂ Score and the Development of Interatrial Block

“…Second, Pwave duration was measured manually and not with semiautomatic calipers, 33,34) which is considered a more sophisticated way to determine P-wave duration. Third, because a higher CHADS2 score is associated with a higher risk of AF, 3,18) more patients with a higher CHADS2 score may have had AF at baseline. Thus, some patients with high CHADS2 scores were excluded from the study population because patients with known AF were excluded from this study.…”

“…1) A recent review of the prevalence of IAB described this condition as being an under-appreciated clinical pandemic, particularly in the aging population. 2) IAB can be associated with a multitude of medical conditions, including atrial fibrillation (AF), [3][4][5][6][7][8] left atrial electromechanical dysfunction, 1,9) thromboembolic ischemic stroke, [10][11][12][13] and increased cardiovascular and all-cause mortalities. 14) Therefore, it is crucial that patients who are at an increased risk for developing IAB are identified.…”

P‐wave and interatrial block: New predictor for atrial high rate episodes in patients with cardiac implantable electronic devices

“…Ariyarajah et al . found a higher IAB prevalence in patients with previous embolic stroke than in patients with a nonembolic stroke (61% vs 41%; P < 0.05) and some other studies also support the same relation between the presence of advanced IAB and the development of AF and ischemic stroke …”

Predictive value of unshielded magnetocardiographic mapping to differentiate atrial fibrillation patients from healthy subjects

“…A systematic review and meta‐analysis has shown that IAB is a significant predictor of new onset AF, with hazard ratio (HR) of 2.42, and of AF recurrence after ablation (HR: 2.59; Tse et al, ). Wu et al showed that IAB in SR and CHADS 2 score independently and synergistically predicted new‐onset AF (Wu et al, ). A positive predictive accuracy of 79% in separating patients with PAF from control subjects has been reported with ECG measurement of PWD using a P maximum value of 106 ms (Pérez‐Riera et al, ).…”