Advanced interatrial block predicts clinical recurrence of atrial fibrillation after catheter ablation

Wu, Jintao; Dong, Jianzeng; Wang, Shanling; Fan, Xian‐Wei; Huang, Yang; Duan, Hongbo; Yan, Li; Peng, Qian; Yang, Chao-Kuan

doi:10.1016/j.jjcc.2015.10.015

Cited by 40 publications

(38 citation statements)

References 49 publications

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“…First, advanced IAB is likely a presentation of AP‐independent atrial electrophysiological abnormalities that remain after successful AP ablation. In support of this, advanced IAB was previously reported to reflect the underlying atrial substrate with atrial fibrosis and to be associated with the development of AF . Second, advanced IAB may play a role in initiating and maintaining reentry circuits by promoting the occurrence of unidirectional block, an important mechanism in the development of AF.…”

Section: Discussionmentioning

confidence: 66%

“…ECGs were manually analyzed on a computer screen using digital calipers with scanning at 300 dots per square inch and 4‐fold image amplification. P‐waves were measured manually using digital calipers for all 12 ECG leads to identify the longest P‐wave duration, as previously described . Advanced IAB was defined as a P‐wave of >120 ms accompanied by a biphasic (±) morphology in the inferior leads (Figure ) .…”

Section: Methodsmentioning

confidence: 99%

“…10 The appearance of advanced IAB is frequently associated with atrial tachyarrhythmias, and has been found to predict AF in multiple clinical scenarios. [12][13][14][15][16][17][18][19][20] However, the role of advanced IAB in predicting the recurrence of AF after AP ablation in patients with WPW syndrome is unclear. Thus, in the present study, we investigated the clinical utility of advanced IAB for predicting the risk of AF recurrence in patients with verified paroxysmal AF and WPW syndrome after successful AP ablation.…”

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

confidence: 99%

“…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 . The appearance of advanced IAB is frequently associated with atrial tachyarrhythmias, and has been found to predict AF in multiple clinical scenarios . However, the role of advanced IAB in predicting the recurrence of AF after AP ablation in patients with WPW syndrome is unclear.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 66%

Section: Methodsmentioning

confidence: 99%

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

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…In recent years, this conduction disorder has become important due to its demonstrated clinical relevance, association with atrial fibrillation (AF), ischemic stroke, cognitive impairment, and prognosis [2, 5-8]. Even, in some patients with stable coronary disease, exercise-induced prolongation of the P wave has been described [9].…”

Section: Introductionmentioning

confidence: 99%

Prognostic of Interatrial Block after an Acute ST-Segment Elevation Myocardial Infarction

et al. 2019

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Background: The influence of interatrial block (IAB) in the prognosis after an acute ST-segment elevation myocardial infarction (STEMI) is unknown. Objectives: To assess the prognostic impact of IAB after an acute STEMI regarding long-term mortality, development of atrial fibrillation, and stroke. Methods: Registry of 972 consecutive patients with STEMI and sinus rhythm at discharge, with a long-term follow-up (49.6 ± 24.9 months). P wave duration was analyzed using digital calipers, and patients were divided into three groups: normal P wave duration (<120 ms), partial IAB (pIAB) (P wave ≥120 ms and positive in inferior leads), and advanced IAB (aIAB) (P wave ≥120 ms plus biphasic [positive/negative] morphology in inferior leads). Results: Mean age was 62.6 ± 13.5 years. A total of 708 patients had normal P wave (72.8%), 207 pIAB (21.3%), and 57 aIAB (5.9%). Patients with aIAB were older (mean age 73 years) than the rest (62 years in the other two groups, p < 0.001). They also had a higher rate of hypertension (70 vs. 55% in pIAB and 49% in normal P wave, p = 0.006) and higher all-cause mortality (26.3 vs. 12.6% in pIAB and 10.3% in normal P wave, p = 0.001). However, multivariable analysis did not show an independent association between IAB and prognosis. Conclusion: About a quarter of patients discharged in sinus rhythm after an acute STEMI have IAB. Patients with aIAB have a poor prognosis, although this is explained mainly by the association of aIAB with age and other variables.

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Effect of pulmonary vein isolation on atrial fibrillation recurrence after accessory pathway ablation in patients with Wolff‐Parkinson‐White syndrome

Zhao

et al. 2020

Clinical Cardiology

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Background: Although successful ablation of the accessory pathway (AP) eliminates atrial fibrillation (AF) in some of patients with Wolff-Parkinson-White (WPW) syndrome and paroxysmal AF, in other patients it can recur. Hypothesis: Whether adding pulmonary vein isolation (PVI) after successful AP ablation effectively prevents AF recurrence in patients with WPW syndrome is unknown. Methods: We retrospectively studied 160 patients (102 men, 58 women; mean age, 46 ± 14 years) with WPW syndrome and paroxysmal AF who underwent AP ablation, namely 103 (64.4%) undergoing only AP ablation (AP group) and 57 (35.6%) undergoing AP ablation plus PVI (AP + PVI group). Advanced interatrial block (IAB) was defined as a P-wave duration of >120 ms and biphasic (±) morphology in the inferior leads, using 12-lead electrocardiography (ECG). Results: During the mean follow-up period of 30.9 ± 9.2 months (range, 3-36 months), 22 patients (13.8%) developed AF recurrence. The recurrence rate did not differ in patients in the AP + PVI group and AP group (15.5% vs 10.5%, respectively; P = .373). Univariable and multivariable Cox regression analyses showed that PVI was not associated with the risk of AF recurrence (hazard ratio, 0.66; 95% confidence interval, 0.26-1.68; P = .380). In WPW patients with advanced IAB, the recurrence rate was lower in patients in the AP + PVI group vs the AP group (90% vs 33.3%, respectively; P = .032). Conclusions: PVI after successful AP ablation significantly reduced the AF recurrence rate in WPW patients with advanced IAB. Screening of a resting 12-lead ECG immediately after AP ablation helps identify patients in whom PVI is beneficial.

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Advanced interatrial block predicts clinical recurrence of atrial fibrillation after catheter ablation

Abstract: Patients with advanced IAB were at an increased risk of AF recurrence after catheter ablation.

Cited by 40 publications

References 49 publications

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

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

Prognostic of Interatrial Block after an Acute ST-Segment Elevation Myocardial Infarction

Effect of pulmonary vein isolation on atrial fibrillation recurrence after accessory pathway ablation in patients with Wolff‐Parkinson‐White syndrome

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