Atypical advanced interatrial blocks: Definition and electrocardiographic recognition

Luna, Antoni Bayés de; Escobar‐Robledo, Luis Alberto; Aristizabal, David; Restrepo, Danilo Weir; Mendieta, Guiomar; Roessel, Albert Massó van; Elosúa, Roberto; Bayés‐Genís, Antoni; Martínez‐Sellés, Manuel; Baranchuk, Adrián

doi:10.1016/j.jelectrocard.2018.09.004

Cited by 56 publications

(67 citation statements)

References 7 publications

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“…P-wave morphology was assessed by observation of the inferior leads (II, III, and aVF). 13 , 14 Interatrial block (IAB) was defined as bimodal (positive/negative) P-wave morphology with an initial upward deviation from the baseline and a final downward deviation towards the baseline ( Supplementary material online , Figure S2 ). Normal atrial conduction was considered as a P-wave duration of 120 ms regardless of morphology; partial IAB was defined as a P-wave ≥120 ms without bimodal morphology; and advanced IAB was defined as a P-wave ≥120 ms with bimodal morphology.…”

Section: Methodsmentioning

confidence: 99%

Predictors of recurrence of atrial fibrillation within the first 3 months after ablation

et al. 2020

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Aims Freedom from atrial fibrillation (AF) at 1 year can be achieved in 50–70% of patients undergoing catheter ablation. Recurrent AF early after ablation most commonly terminates spontaneously without further interventional treatment but is associated with later recurrent AF. The aim of this investigation is to identify clinical and procedural factors associated with recurrence of AF early after ablation. Methods and results We retrospectively analysed data for recurrence of AF within the first 3 months after catheter ablation from the randomized controlled AXAFA–AFNET 5 trial, which demonstrated that continuous anticoagulation with apixaban is as safe and as effective compared to vitamin K antagonists in 678 patients undergoing first AF ablation. The primary outcome of first recurrent AF within 90 days was observed in 163 (28%) patients, in which 78 (48%) patients experienced an event within the first 14 days post-ablation. After multivariable adjustment, a history of stroke/transient ischaemic attack [hazard ratio (HR) 1.54, 95% confidence interval (CI) 0.93–2.6; P = 0.11], coronary artery disease (HR 1.85, 95% CI 1.20–2.86; P = 0.005), cardioversion during ablation (HR 1.78, 95% CI 1.26–2.49; P = 0.001), and an age:sex interaction for older women (HR 1.01, 95% CI 1.00–1.01; P = 0.04) were associated with recurrent AF. The P-wave duration at follow-up was significantly longer for patients with AF recurrence (129 ± 31 ms vs. 122 ± 22 ms in patients without AF, P = 0.03). Conclusion Half of all early AF recurrences within the first 3 months post-ablation occurred within the first 14 days post-ablation. Vascular disease and cardioversion during the procedure are strong predictors of recurrent AF. P-wave duration at follow-up was longer in patients with recurrent AF. Trial registration Clinicaltrials.gov identifier NCT02227550, https://clinicaltrials.gov/ct2/show/NCT02227550?term=NCT02227550.&rank=1

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Section: Methodsmentioning

confidence: 99%

Predictors of recurrence of atrial fibrillation within the first 3 months after ablation

et al. 2020

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“…P waves showed increased duration (>120 ms). The polarity of the P wave in lead III and aVF was biphasic (positive-negative) consistent with aIAB (3,4). In lead II, the P wave showed a triphasic pattern (positive-negative-positive), which just recently was defined as atypical aIAB (3).…”

Section: Ecg Description and Discussionmentioning

confidence: 99%

Interatrial block and ischemic stroke

Lindow

Baranchuk

2018

J. Thorac. Dis

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“…Patients were classified as having either no IAB (PWD < 120 ms), pIAB (PWD ≥120 ms, positive P waves in leads II and aVF) or aIAB (PWD 120 ms and biphasic [±] or negative P waves in leads II or aVF). The definition [13] was established on the notion that aIAB diagnosis should primarily be based on leads II and aVF and that isolated abnormal morphologies in lead III are not sufficiently specific for aIAB [19]. Illustrations of the different IAB types are found in Figure 1.…”

Section: Baseline Ecg Assessment and Definitions Of Iab And Abnormal mentioning

confidence: 99%

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

et al. 2020

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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.

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Atypical advanced interatrial blocks: Definition and electrocardiographic recognition

Cited by 56 publications

References 7 publications

Predictors of recurrence of atrial fibrillation within the first 3 months after ablation

Predictors of recurrence of atrial fibrillation within the first 3 months after ablation

Interatrial block and ischemic stroke

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

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