Baseline ECG and Prognosis After Transcatheter Aortic Valve Implantation: The Role of Interatrial Block

Abstract

Background The clinical significance of conduction disturbances after transcatheter aortic valve implantation has been described; however, little is known about the influence of baseline ECGs in the prognosis of these patients. Our aim was to study the influence of baseline ECG parameters, including interatrial block (IAB), in the prognosis of patients treated with transcatheter aortic valve implantation. Methods and Results The BIT (Baseline Interatrial Block and Transcatheter Aortic Valve Implantation) registry included 2527 patients with aortic stenosis treated with transcatheter aortic valve implantation. A centralized analysis of baseline ECGs was performed. Patients were divided into 4 groups: normal P wave duration (<120 ms); partial IAB (P wave duration ≥120 ms, positive in the inferior leads); advanced IAB (P wave duration ≥120 ms, biphasic [+/–] morphology in the inferior leads); and nonsinus rhythm (atrial fibrillation/flutter and paced rhythm). The mean age of patients was 82.6±9.8 years and 1397 (55.3%) were women. A total of 960 patients (38.0%) had a normal P wave, 582 (23.0%) had partial IAB, 300 (11.9%) had advanced IAB, and 685 (27.1%) presented with nonsinus rhythm. Mean follow‐up duration was 465±171 days. Advanced IAB was the only independent predictor of all‐cause mortality (hazard ratio [HR], 1.48; 95% CI, 1.10–1.98 [ P =0.010]) and of the composite end point (death/stroke/new atrial fibrillation) (HR, 1.51; 95% CI, 1.17–1.94 [ P =0.001]). Conclusions Baseline ECG characteristics influence the prognosis of patients with aortic stenosis treated with transcatheter aortic valve implantation. Advanced IAB is present in about an eighth of patients and is associated with all‐cause death and the composite end point of death, stroke, and new atrial fibrillation during follow‐up.

Interatrial block, atrial fibrillation, and thrombotic events in COVID‐19

“…We read with great interest the study of Russo et al 1 regarding the prognostic role of interatrial block (IAB) among hospitalized COVID‐19 patients. Although the prognostic role of IAB has been previously described in several settings, 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 this is the first report regarding the association of IAB with a poor prognosis in COVID‐19. The authors found that advanced IAB was an independent predictor of thrombotic events but did not include the data regarding patients with baseline atrial fibrillation.…”

The Prevalence of Advanced Interatrial Block and Its Relationship to Left Atrial Function in Patients with Transthyretin Cardiac Amyloidosis

“…In recent years, aIAB has been reported for other populations as well, such as patients treated with transcatheter aortic valve implantation (12%) [33], patients with ST-elevation myocardial infarction (6%) [34] or takotsubo cardiomyopathy (5%) [35], patients with human immunodeficiency virus (4%) [36], etc.…”

New Parameter of the Second Half of the P-Wave, P-Wave Duration, and Atrial Conduction Times Predict Atrial Fibrillation during Electrophysiological Studies

“…Several P-wave parameters on the surface electrocardiogram, particularly "interatrial block," are good predictors of AF [17,18]. In elderly patients enrolled in the PRE-DICTOR study, interatrial block strongly predicted AF indicating more than triple the risk [19].…”