Interatrial Block In Patients Research Articles

Association of the interatrial block and left atrial fibrosis in the patients without history of atrial fibrillation.

Presence of left atrial (LA) fibrosis reflects underlying atrial cardiomyopathy. Interatrial block (IAB) is associated with LA fibrosis in patients with atrial fibrillation (AF). The association of IAB and LA fibrosis in the patients without history of AF is unknown. We examined association of IAB and LA fibrosis in the patients without AF history. This is a retrospective analysis of 229 patients undergoing cardiac magnetic resonance imaging (CMR). LA fibrosis was reported from spatial extent of late gadolinium enhancement of CMR. IAB was measured from 12-lead electrocardiography using digital caliper. Of 229 patients undergoing CMR, prevalence of IAB was 50.2%. Patients with IAB were older (56.9±13.9 years vs. 45.9±19.2 years, p<0.001) and had higher prevalence of co-morbidities. Left ventricular ejection fraction was lower in IAB group. LA volume index (LAVI) was greater in IAB group (54.6±24.9 ml/m2 vs. 43.0±21.1 ml/m2, p<0.001). Patients with IAB had higher prevalence of LA fibrosis than those without IAB (70.4% vs. 21.2%; p<0.001). After multivariable analysis, only IAB and LAVI were independent factors that predict LA fibrosis. Prevalence of IAB in patients undergoing CMR was high. IAB was highly associated with LA fibrosis and larger LA size in patients without AF history.

Inter-atrial block and atrial fibrillation predict cardiac adverse events in heart failure with preserved ejection fraction

Abstract Background Atrial fibrillation (AF) is a prognostic risk-factor in heart failure with preserved ejection fraction (HFpEF). Earlier stages of atrial dysfunction identified by the ECG, particularly inter-atrial block (IAB), may provide additional risk predictions in HFpEF patients in sinus rhythm. Purpose To assess the prevalence of IAB in patients diagnosed with HFpEF compared to non-HFpEF, and to evaluate the prognostic association of IAB and AF in patients diagnosed with HFpEF. Methods Consecutive symptomatic patients referred for a systematic diagnostic work-up to rule-in or rule-out HFpEF were included. The diagnosis of HFpEF was based on current guidelines (including HFA-PEFF and H2FPEF algorithms) and confirmed by consensus of multiple experienced HF specialists. Patients in whom HFpEF was ruled-out were included as non-HFpEF. We excluded patients with cardiac valve interventions before or up to 1 year after baseline, or with paced rhythm during IAB assessment. ECGs at baseline were assessed in detail for P-wave duration, morphology, and presence of IAB using digital calipers by investigators blinded to clinical data. IAB was defined based on a P-wave duration of &amp;gt;120ms. Patients with HFpEF and non-HFpEF were grouped into either i) AF based on ECG or medical history, ii) IAB based on ECG, or iii) no IAB or AF based on ECG. Adverse events were evaluated only in HFpEF patients and included HF hospitalization, cardiac or sudden death, and a composite of both. Results 372 patients with HFpEF and 68 non-HFpEF were included (females: 67.7% vs. 64.7%, p = 0.726; mean age: 75±7 vs. 67±10 years, p&amp;lt;0.001). AF was more common in HFpEF than non-HFpEF (64.8% vs. 23.5%, p&amp;lt;0.001). In sinus rhythm, presence of IAB was comparable between HFpEF and non-HFpEF (87.0% vs. 80.8%). During a mean follow-up of 3.2±1.6 years in HFpEF patients, more adverse cardiac events were observed when AF was present (23.7%, HR 10.6 [95%CI 1.5-1334.4]) compared to IAB (10.5%, HR 4.2 [95%CI 0.56-542.6]) and no IAB (0%), p = 0.0004 (Figure 1). Pairwise comparisons confirmed these observations: AF vs. IAB p = 0.006, AF vs. no IAB p = 0.031. In HFpEF patients with sinus rhythm, a trend was found for more adverse events when IAB was present versus no IAB (p = 0.06). Conclusion Patients with HFpEF have a higher prevalence of AF and similar prevalence of IAB compared to symptomatic patients ruled-out for HFpEF. Presence of IAB or AF in HFpEF may predispose to adverse cardiac events in patients without severe valve disease. IAB may enrich cardiac risk stratification in addition to AF in HFpEF.Survival curves for no IAB, IAB, and AF

Presystolic wave as a predictor of interatrial block in patients with supraventricular tachycardia.

The identification of interatrial block (IAB) through electrocardiography (ECG) has been correlated with an elevated likelihood of developing atrial fibrillation (AF) and stroke. IAB is diagnosed by evaluating P-wave prolongation on a surface ECG. The presystolic wave (PSW) is an echocardiographic marker determined by pulse-wave examination of the aortic root during late diastole. As IAB and PSW share similar pathophysiological mechanisms, we speculated that PSW, as a component of the P wave, might be useful in predicting IAB. In the present study, we aimed to determine the relationship between PSW and IAB. Patients with pre-diagnosis of supraventricular tachycardia (SVT) on electrocardiography or rhythm Holter monitoring between January 2021 and December 2022 were included in the study. Surface 12-lead ECG and transthoracic echocardiography (TTE) were performed for the diagnosis of IAB and PSW. Patients were divided into two groups based on the presence of IAB, and PSW was compared between the groups. In total, 104 patients were enrolled in this study. IAB was diagnosed in 16 patients (15.3%) and PSW was detected in 33 patients (31.7%). The PSW was higher in the IAB ( +) group than in the IAB ( -) group (10 patients (71.4%) vs. 23 patients (32.4%), p = 0.008). PSW may be a useful tool for predicting IAB in patients with SVT. Further studies are needed to determine the clinical utility of PSW in the diagnosis and management of IAB.

Evaluation of Electrocardiographic Parameters and the Presence of Interatrial Block in Patients with Mad Honey Intoxication.

Mad honey intoxication (MHI) is a food-induced clinical condition that usually presents with cardiovascular symptoms and can lead to life-threatening arrhythmias if not diagnosed and treated early. No data exist in the literature on the presence of interatrial block (IAB) after food intoxication. In our study, we sought to investigate atrioventricular electrocardiography (ECG) parameters and determine the frequency of IAB in patients with MHI. In total, 76 patients diagnosed with MHI were included in our retrospective study. Twelve-lead ECGs were performed and participants were divided into two groups according to the presence of IAB in the reference ECG. The P maximum (Pmax), P minimum (Pmin), P dispersion (Pdisp), T peak to T end (Tp-Te) interval and QT dispersion (QTdisp) values were compared between the two groups. IAB was detected in 28 (35.5%) of 76 MHI patients included in the final analysis. Pmax duration (122 ± 8; p < 0.001) and PD (69 ± 11; p < 0.001) were significantly higher in the IAB ( +) group. During regression analysis, Pmax [odds ratio (OR) 1.158, 95% confidence interval (CI) 1.036-1.294; p = 0.010] and Pd (OR 1.086, 95% CI 1.001-1.017; p = 0.046) were independently associated with IAB. Pmax and Pd area under the receiver operating characteristic curve values for IAB prediction were 0.926 (95% CI 0.841-1,000; p < 0.001) and 0.872 (95% CI 0.765-0.974; p < 0.001), respectively. ECG changes are common in patients presenting with MHI. These patients need to be followed up clinically in terms of progression to arrhythmic events that may occur in the future.

Impaired left atrial strain in the presence of interatrial block in patients with type 2 diabetes mellitus.

Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases, and is a risk factor for atrial cardiomyopathy. Interatrial block (IAB), as a predictor of AF, is correlated with the extent of LA fibrosis in the process of atrial cardiomyopathy. We have not encountered any study evaluating LA and LV functions with 3D-STE in the presence of IAB in the T2DM patients. The purpose of the present study was to compare the LA and LV myocardial functions in patients with T2DM with and without IAB by 3D-STE. A total of 175 consecutive patients with T2DM who were examined at outpatient clinics were enrolled in the study (85 patients with IAB and 90 patients without IAB). Surface 12-lead standard electrocardiograms (ECGs) were recorded. Clinical characteristics and laboratory values of the patients were obtained. Conventional 2D echocardiographic and 3D-STE analyses were performed. The mean age of the patients was 59 ± 8.7 years, and 112 (64%) of the patients were female. The LAS-r and LAS-active were significantly decreased in the IAB (+) group than in the IAB (-) group. Statistically significant strong negative linear correlations were observed between P-wave duration and 3D-LA strain values. Our results indicate that there is an impairment in LA myocardial dynamics in the presence of IAB in T2DM patients. According to these findings, we can say that it will be useful to evaluate the LA functions at the preclinical stage in the presence of IAB in patients with T2DM, when considering ischemic cardiovascular and cerebral events.

Evaluation of Interatrial Block in Patients Presented with Acute Pulmonary Embolism

Evaluation of Interatrial Block in Patients Presented with Acute Pulmonary Embolism

Advanced interatrial block in patients with systemic arterial hypertension and atrial fibrillation

Systemic arterial hypertension (AHT) continues to be a risk factor of undoubted importance in the process of development of cardiovascular disease and atrial fibrillation (AF). AF is the most frequently detected sustained arrhythmia. For this reason, it is essential to give the necessary emphasis to the prevention and early diagnosis of diseases with great social, medical and economic impact on public health. In this context, it is important to detect the subclinical stage disease and identify factors that determine with great reliability the appearance and development of a disease. The electrocardiogram (ECG) is a safe, inexpensive auxiliary diagnostic method, easy to use and accessible in practically all medical centers, and which serves to detect various nosological entities. The interatrial block (IAB) diagnosed by the ECG occurs due to a slowing down of conduction between the right and left atria due to a delay in the conduction of impulses through the Bachmann pathway. The anatomical substrate for IAB is produced by atrial remodeling due to fibrosis, inducing interatrial dyssynchrony. IAB is present in up to 59% of older patients in the general population and was directly associated with AHT and AF. In addition, advanced IAB was associated with a 3-fold increased risk of new-onset AF and ischemic stroke. Therefore, it is essential to carry out additional prospective research to determine the optimal strategies in the adequate therapeutic management of these patients

Prevalence, clinical profile and prognostic implications of interatrial block in patients admitted for heart failure

Introduction and objectivesTo describe the prevalence, clinical profile, and prognostic significance of interatrial block (IAB) in heart failure (HF) inpatients. MethodsWe included prospectively 557 hospitalized HF patients with sinus rhythm from nationwide registry. Partial IAB was defined as a P wave duration ≥120ms, and advanced IAB as a P wave duration ≥120ms with biphasic morphology in inferior electrocardiogram (ECG) leads. Clinical, blood test, and echocardiographic data were analyzed in a Cox regression to determine the impact of IAB at discharge on prognosis. The primary outcome was a composite of mortality or readmission for HF at 1-, 6-, and 12-month. ResultsNormal P wave, partial, and advanced IAB were identified in the discharge ECG in 336 (60.3%), 118 (21.1%), and 103 (18.5%) patients, respectively. The independent factors related to IAB at discharge were previous history of HF (OR, 1.78; 95%CI, 1.23–2.57), valvular HF etiology (OR, 1.88; 95%CI, 1.18–3.00), heart rate at admission (OR, 1.10 per 10 beats; 95%CI, 1.03–1.17) and left atrial diameter (OR, 1.24 per 5mm; 95%CI, 1.11–1.38). The incidence of 1-, 6-, and 12-month mortality/readmission for HF was 4.8%, 7.7%, and 33.0% in normal P wave, 1.7%, 7.6%, and 33.2% in partial IAB, and 3.9%, 9.7%, and 36.9% in advanced IAB. Multivariable analysis showed no significant effect of IAB in major acute cardiovascular events. ConclusionsIAB is found in 40% of patients in sinus rhythm discharged after a HF hospitalization. This ECG pattern at discharge does not imply a greater risk of readmission or death during the first year.

ST-segment elevasyonlu akut miyokard infarktüsü ile başvuran hastalarda interatrial ileti bozuklukları

Aim: The most significant clinical association of interatrial block (IAB) was found with increased risk of atrial fibrillation and ischemic stroke. In this study, we sought to evaluate P wave duration and interatrial block in patients presented with acute ST-segment-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). Materials and Methods: We performed a retrospective analysis of patients presented with acute STEMI who underwent emergent PCI. Follow-up electrocardiograms were obtained from electronic database system. Echocardiographic data were also obtained from electronic patient records. Electrocardiographic measurements were performed using SEMA Workstation 3.8.1 (Schiller AG). Results: Primary analysis included 200 consecutive patients with STEMI. However, there were 20 in-hospital deaths and 83 patients were lost to follow-up. Remaining 97 patients (80 male, 17 female) were included in the final analysis. Mean age was 57.0212.18 years. There were 48 patients with anterior STEMI and 49 patients with inferior STEMI. Mean duration of follow-up was 11 months and ECGs at the end of the follow up revealed that the frequency of partial and advanced IAB were 13.2% and 7.7% respectively. Statistical analysis showed that neither P wave duration nor IAB showed significant association with the infarct related artery lesion localization. Also, the degree of systolic dysfunction was not associated with IAB. Only male gender and left atrial diameter had significant positive correlation with P wave duration. Conclusion: IAB was not rare in patients with a history of acute coronary syndrome. The infarct related artery does not seem to have a significant correlation with interatrial conduction.

Echocardiographic predictors of interatrial block in patients with severe chronic kidney disease.

Interatrial block (IAB), defined as a conduction delay between the right and left atrium, is manifested on the electrocardiogram as a prolonged P-wave duration. Large number of studies recently have been published regarding the prevalence of IAB and its associations with the risk of atrial fibrillation and ischemic stroke. Cardiovascular diseases are the leading causes of mortality in chronic kidney disease (CKD). In this study, we aimed to investigate echocardiographic predictors of IAB in patients with severe CKD. This study enrolled a total of 155 patients [male: 95 (61.3%), mean age: 56.3 ± 12.8years] with severe CKD (glomerular filtration rate < 30mL/min). All patients were evaluated by electrocardiography and transthoracic echocardiography. IAB was defined as P wave duration of ≥ 120ms on electrocardiography. Electrocardiography revealed IAB in 54 patients. The baseline demographic characteristics of the patients were similar in both groups with and without IAB. Left atrial diameter (LAD), left ventricular end-systolic and end-diastolic diameters, interventricular septal thickness, posterior wall thickness, left ventricular mass, left ventricular mass index (LVMI), and the prevalence of left ventricular hypertrophy were found to be significantly increased in patients with IAB. Increased LAD (OR = 1.119; 95% CI 1.019-1.228; p = 0.019) and LVMI (OR = 1.036; 95% CI 1.003-1.070; p = 0.031) were found to be independent predictors of IAB. A significant association exists between the presence of IAB and echocardiographic parameters related to left ventricular hypertrophy and left atrial dilatation. Presence of IAB may be an additional and easy diagnostic marker for risk stratification of patients with severe CKD.

Comparison of clinical features and conventional echocardiographic characteristics of patients with heart failure with mid-range ejection fraction with and without interatrial block

Heart failure with mid-range ejection fraction (HFmrEF) has been proposed as a distinct heart failure (HF) phenotype. Interatrial block (IAB) is a conduction delay between the atria and is associated with cardiovascular disease. Although there are several studies examining the effect of IAB in patients with HF with reduced ejection fraction and HF with preserved ejection fraction, a literature review did not reveal any study investigating the clinical importance of the presence of IAB in patients with HFmrEF. Thus, the aim of this research was to evaluate clinical characteristics of HFmrEF with and without IAB.A total of 520 consecutive patients with HFmrEF in sinus rhythm who were examined at outpatient clinics were enrolled in the study (244 patients with IAB and 276 patients without IAB). Surface 12-lead standard electrocardiograms (ECGs) were recorded. Clinical characteristics, echocardiographic examination results, and laboratory values of the patients were recorded.The mean age of the patients was 67.4±11.1 years, and 76.1% were male. The patients with IAB had more comorbidities, including hypertension, diabetes mellitus, and stroke/transient ischemic attack. A statistically significant, strong, positive linear correlation was observed between P-wave duration and age, systolic blood pressure, and left atrial volume index (r=0.718, p<0.001; r=0.704, p<0.001; and r=0.725, p<0.001, respectively).To the best of our knowledge, the present study is the first to evaluate the clinical relevance of IAB in HFmrEF. Adding this simple ECG marker to the clinical evaluation could add significantly to the management of HFmrEF. IAB can be used to identify high-risk HFmrEF patients, as well as to guide follow-up and appropriate treatment.

P3838Evaluation of echocardiographic determinants of interatrial block in patients with essential hypertension

Abstract Introduction Interatrial block (IAB), defined as a conduction delay between the right and left atrium, is manifested on the electrocardiogram as a prolonged P-wave duration. Large number of studies recently have been published regarding the prevalence of IAB and its associations with cardiovascular events. It has been previously reported that myocardial fibrosis may cause conduction delays in hypertensive patients. In this study, we aimed to investigate the echocardiographic determinants of IAB in patients with hypertension. Methods This study enrolled a total of 220 patients [male: 93 (42.3%), mean age: 61.8±7.8 years] with hypertension. Patients with atrial fibrillation were excluded. IAB was defined as P wave duration of ≥120 ms with or without presence of notching. Routinely obtained 12-lead electrocardiography recordings were examined, and patients were divided into two groups as those with and without IAB. All patients were evaluated by transthoracic echocardiography. Results Electrocardiography revealed IAB in 70 patients. The baseline demographic characteristics of the patients with and without IAB were similar in both groups. Left atrial diameter (LAD), interventricular septal thickness, posterior wall thickness, left ventricular mass, left ventricular mass index, and the prevalence of left ventricular hypertrophy (LVH) were found to be significantly increased in hypertensive patients with IAB. Increased LAD (OR=1.082; 95% CI: 1.006–1.164; p=0.034) and LVH (OR=3.051; 95% CI: 1.164–7.994; p=0.023) were found to be independent predictors of IAB. In the receiver operating characteristic curve analyses, LAD values above 38 mm predicted IAB with a sensitivity of 68%, and a specificity of 58% (AUC= 0.678; 95% CI: 0.601–0.754; p&lt;0.001). Conclusion A significant association exists between the presence of IAB and echocardiographic parameters related to left ventricular hypertrophy and left atrial dilatation in patients with essential hypertension. The presence of IAB may be used as an electrocardiographic marker of cardiac remodelling and myocardial fibrosis in hypertensive patients.

Prevalence and Significance of Interatrial Block in Takotsubo Syndrome (from the RETAKO Registry)

Interatrial block (IAB) represents a conduction delay between right and left atria and is associated with an increased risk of atrial fibrillation and stroke. IAB has not been previously assessed in patients with Takotsubo syndrome (TS). Our aim was to describe the prevalence and prognostic significance of IAB in patients with TS. Data come from the Spanish National prospective registry of patients with definitive TS diagnosis. IAB was defined as a P-wave ≥120 ms and was considered partial when the P-wave was positive in inferior leads and advanced when it was biphasic (+/-). A total of 246 patients were included, normal P-wave was found in 151 (61%), partial IAB in 58 (24%), atrial fibrillation in 18 (7%), advanced IAB in 13 (5%), and 6 (2%) were pacemaker dependent. During a mean follow up of 12 months the composite of all-cause mortality and hospital readmission was significantly higher in patients with advanced IAB (31%) or atrial fibrillation (33%) than in the rest of the cohort (pacemaker stimulation 17%, normal P-wave 13%, partial IAB 12%), p < 0.01. The data regarding P wave characteristics were an independent predictor of the composite end point all-cause death and hospital readmission. IAB has a high prevalence in patients with TS. Advanced IAB and atrial fibrillation are associated with a poor prognosis.

Advanced Interatrial Block in Patients with Paroxysmal Atrial Fibrillation Before and After Catheter Ablation

Advanced Interatrial Block in Patients with Paroxysmal Atrial Fibrillation Before and After Catheter Ablation

Advanced Interatrial Block in Patients with Paroxysmal Atrial Fibrillation Before and After Catheter Ablation

Advanced Interatrial Block in Patients with Paroxysmal Atrial Fibrillation Before and After Catheter Ablation

Prevalence of P wave dispersion and interatrial block in patients with systolic heart failure and their relationship with functional status, hospitalization and one year mortality

Background and objectivesP-wave dispersion (PWD) and Interatrial block (IAB) are common in heart failure (HF), and could be associated with adverse cardiac events. We aimed to assess the prevalence of PWD and IAB and their relationship with functional status, hospitalization and mortality rate in patients with systolic HF.MethodsWe enrolled 110 HF patients in sinus rhythm & LVEF <50%. Patients had undergone clinical evaluation, 6 min walking test (6MWT), 12-lead electrocardiography (ECG), 24-h Holter ECG & echocardiogram. Hospitalization and mortality rate were followed-up for one year. PWD was defined as the difference between maximum & minimum P-wave duration >40 ms. IAB was defined as maximum P duration >110 ms. Measurements were done by 2 blinded investigators using a caliber, a ruler and a magnifying lens.ResultsMean age was 58.9 ± 9.7 years and 67.3% were males. Prevalence of PWD and IAB was 68.2% and 57.3%, respectively. Patients with PWD showed these features: 84% in NYHA class III or IV HF, 77.4% had LVEF <35%, 78.7% had paroxysmal Atrial Fibrillation (AF) and 89.4% couldn’t complete >200 m (m) in 6MWT. Patients with PWD had more hospitalizations (72% vs 28.6%, P value <0.02) and higher 1-year mortality rate (20% vs 8.6%, P value <0.04) than patients without PWD. Likewise, patients with IAB had nearly similar clinical features, hospitalization and mortality as patients with PWD.ConclusionPWD and IAB are prevalent in patients with systolic HF and they are significantly associated with low LVEF, paroxysmal AF, poor functional capacity, hospitalization and mortality rate.

PREVALENCE, CLINICAL PROFILE AND SHORT-TERM PROGNOSIS OF INTERATRIAL BLOCK IN PATIENTS ADMITTED FOR WORSENING OF HEART FAILURE

Interatrial block (IAB) is a poorly recognized cardiac rhythm disorder characterized by a prolonged P wave and associated with supraventricular arrhythmias. Our aim was to describe the prevalence, clinical profile and short-term prognosis of IAB in patients admitted for worsening of heart failure (

Prevalence of interatrial block in patients undergoing coronary bypass graft surgery

Prevalence of interatrial block in patients undergoing coronary bypass graft surgery

Electrocardiographic criteria for interatrial block

I congratulate the authors of interesting paper ‘‘Electrocardiographic P-wave characteristics in patients with end-stage renal disease: P-index and interatrial block’’ recently published in your journal [1]. They first reported high prevalence of interatrial block in patients undergoing dialysis. However, it should be noted that the criteria used to define the block are incorrect. In fact, in agreement with their reference number 11 [2] and with Bayes de Luna [3], partial interatrial block was defined as prolonged P-wave (greater or equal to 110 ms) but not ‘‘in all leads,’’ just in largest one. Similarly, bifid P-waves or bimodal morphology was not ‘‘in all’’ but ‘‘usually’’ or ‘‘especially’’ in leads I, aVL, and inferior leads. In addition, advanced or third-degree interatrial block is defined as prolonged and biphasic (? -) P-waves not in ‘‘all 12-leads,’’ but in leads II, III, and aVF. I think it is just a typing error.

Interatrial block in patients with obstructive sleep apnea

Interatrial block in patients with obstructive sleep apnea