Electrocardiographic Advanced Interatrial Block and Atrial Fibrillation Risk in the General Population

O’Neal, Wesley T.; Zhang, Zhu Ming; Loehr, Laura R.; Chen, Lin Y.; Alonso, Álvaro; Soliman, Elsayed Z.

doi:10.1016/j.amjcard.2016.03.013

Cited by 111 publications

(99 citation statements)

References 17 publications

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“…However, the stroke risk associated with PACs remains after accounting for documented cases of atrial fibrillation [5]. Persons with PACs also possibly have left atrial disease in which atrial thromboembolism is possible due to reduced left atrial contractility, leading to reductions in left atrial stroke volume and kinetic energy [15-17]. This concept of atrial cardiopathy is supported by recent findings that have associated left atrial disease with ischemic stroke independent of atrial fibrillation [16,18,19].…”

Section: Discussionmentioning

confidence: 99%

Premature Atrial Contractions on the Screening Electrocardiogram and Risk of Ischemic Stroke: The Reasons for Geographic and Racial Differences in Stroke Study

O’Neal

Kamel²,

Kleindorfer³

et al. 2016

Neuroepidemiology

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Background: It is currently unknown if premature atrial contractions (PACs) detected on the routine screening electrocardiogram are associated with an increased risk of ischemic stroke. Methods: We examined the association between PACs and ischemic stroke in 22,975 (mean age 64 ± 9.2; 56% women; 40% black) participants from the Reasons for Geographic and Racial Differences in Stroke study. Participants who were free of stroke at baseline were included. PACs were detected from centrally read electrocardiograms at baseline. Cox regression was used to examine the association between PACs and ischemic stroke events through March 31, 2014. Results: PACs were present in 1,687 (7.3%) participants at baseline. In a Cox regression model adjusted for stroke risk factors and potential confounders, PACs were associated with an increased risk of ischemic stroke (hazards ratio (HR) 1.34, 95% CI 1.04-1.74). The relationship was limited to non-lacunar infarcts (HR 1.42, 95% CI 1.08-1.87), and not lacunar strokes (HR 1.01, 95% CI 0.51-2.03). An interaction by sex was detected, with the association between PACs and ischemic stroke being stronger among women (HR 1.82, 95% CI 1.29-2.56) than men (HR 1.03, 95% CI 0.69-1.52; p-interaction = 0.0095). Conclusion: PACs detected on the routine electrocardiogram are associated with an increased risk for non-lacunar ischemic strokes, especially in women.

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Section: Discussionmentioning

confidence: 99%

Premature Atrial Contractions on the Screening Electrocardiogram and Risk of Ischemic Stroke: The Reasons for Geographic and Racial Differences in Stroke Study

O’Neal

Kamel²,

Kleindorfer³

et al. 2016

Neuroepidemiology

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“…Advanced IAB is a useful marker to identify subjects who are at high risk for developing atrial fibrillation, and is a pre-atrial fibrillation condition associated with premature atrial beats[24]. …”

Section: Association Of Interatrial Block With Supraventricular Arrhymentioning

confidence: 99%

Bayés syndrome and acute cardioembolic ischemic stroke

Arboix

Martí

Dorison

et al. 2017

WJCC

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Bayés syndrome is an under-recognized clinical condition characterized by advanced interatrial block. Bayés syndrome is a subclinical disease that manifests electrocardiographically as a prolonged P wave duration > 120 ms with biphasic morphology ± in the inferior leads. The clinical relevance of Bayés syndrome lies in the fact that is a clear arrhythmological syndrome and has a strong association with supraventricular arrhythmias, particularly atypical atrial flutter and atrial fibrillation. Likewise, Bayés syndrome has been recently identified as a novel risk factor for non-lacunar cardioembolic ischemic stroke and vascular dementia. Advanced interatrial block can be a risk for embolic stroke due to its known sequelae of left atrial dilation, left atrial electromechanical dysfunction or atrial tachyarrhythmia (paroxysmal or persistent atrial fibrillation), conditions predisposing to thromboembolism. Bayés syndrome may be responsible for some of the unexplained ischemic strokes and shall be considered and investigated as a possible cause for cryptogenetic stroke. In summary, Bayés syndrome is a poorly recognized cardiac rhythm disorder with important cardiologic and neurologic implications.

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“…Other reports have suggested differences in atrial electrophysiology by sex. Advanced interatrial block more commonly develops in men than women, and this electrocardiographic phenotype precedes AF development [20]. Furthermore, sex differences in P-wave indices have been reported, providing support that atrial conduction varies between men and women [21].…”

Section: Discussionmentioning

confidence: 99%

Sex hormones and the risk of atrial fibrillation: The Multi-Ethnic Study of Atherosclerosis (MESA)

et al. 2017

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Purpose Atrial fibrillation (AF) is more prevalent in men than women. Due to these sex differences in AF susceptibility, we examined whether sex hormones have differing associations with AF risk in men and women. Methods This analysis included 4,883 (mean age=63±10 years; 39% women; 64% non-white) participants from the Multi-Ethnic Study of Atherosclerosis. Sex hormones (total testosterone, bioavailable testosterone, estradiol, and sex hormone binding globulin (SHBG)) were measured at baseline (2000–2002) for all male and all postmenopausal female participants. AF was ascertained by hospital discharge records, Medicare claims data, and study electrocardiograms through December 31, 2012. Results Over a median follow-up of 10.9 years, a total of 613 (13%) AF cases were detected. A higher incidence rate of AF was observed for males (n=385, age-standardized incidence rate per 1000 person-years=12.3, 95%CI=11.1, 13.6) than females (n=228, age-standardized incidence rate per 1000 person-years=9.0, 95%CI=7.9, 10.3). In men, higher bioavailable testosterone levels were associated with increased AF risk (HR=1.32, 95%CI=1.01, 1.74; p=0.044; comparing 3rd to 1st tertile), while an association in the opposite direction was observed for women (HR=0.81, 95%CI=0.58, 1.13; p=0.22; comparing 3rd to 1st tertile). Other hormones were not associated with AF in men or women. Conclusion Higher levels of endogenous bioavailable testosterone contribute to AF development in men. The combination of endogenous bioavailable testosterone and other risk factors potentially are important for AF development in men.

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Electrocardiographic Advanced Interatrial Block and Atrial Fibrillation Risk in the General Population

Cited by 111 publications

References 17 publications

Premature Atrial Contractions on the Screening Electrocardiogram and Risk of Ischemic Stroke: The Reasons for Geographic and Racial Differences in Stroke Study

Premature Atrial Contractions on the Screening Electrocardiogram and Risk of Ischemic Stroke: The Reasons for Geographic and Racial Differences in Stroke Study

Bayés syndrome and acute cardioembolic ischemic stroke

Sex hormones and the risk of atrial fibrillation: The Multi-Ethnic Study of Atherosclerosis (MESA)

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