Interatrial Block: A Novel Risk Factor for Embolic Stroke?

Ariyarajah, Vignendra; Puri, Puneet; Apiyasawat, Sirin; Spodick, David H.

doi:10.1111/j.1542-474x.2007.00133.x

Cited by 64 publications

(64 citation statements)

References 16 publications

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“…These results are in accordance with the findings of previous studies [27][28][29] in which IAB was associated with an increased risk of ischemic stroke. However, the underlying mechanism has not been fully explained.…”

Section: Discussionsupporting

confidence: 93%

Usefulness of a Combination of Interatrial Block and a High CHADS<sub>2</sub> Score to Predict New Onset Atrial Fibrillation

Wang

Chu

et al. 2016

Int. Heart J.

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SummaryInteratrial block (IAB) is associated with an increased risk of atrial fibrillation (AF). The aim of this retrospective study was to investigate the association of a combination of IAB and the CHADS 2 score, an AF-related risk score for ischemic stroke, with new onset AF in patients in sinus rhythm. A total of 1,571 patients (803 males, 768 females; mean age: 58 ± 16 years) were included in this study. IAB was defined as a P-wave duration > 120 ms in the 12-lead electrocardiogram, and a high CHADS 2 score as ≥ 2 points. During the mean follow-up period of 4.8 ± 0.7 years, new onset AF occurred in 122 patients (16.1 per 1,000 patient-years). The incidence of new onset AF was 4.0 per 1,000 patient-years in patients with no IAB and a low CHADS 2 score, and 44.0 per 1,000 patient-years in patients with IAB and a high CHADS 2 score. In multivariate Cox regression analysis, the hazard ratio for IAB and a high CHADS 2 score compared with no IAB and a low CHADS 2 score was 12.18 (95% confidence interval: 6.22-23.87, P < 0.001), after adjustment for age, sex, coronary artery disease, valvular heart disease, smoking, medications, and echocardiographic parameters. In conclusion, IAB and a high CHADS 2 score independently and synergistically predict new onset AF in patients in sinus rhythm, indicating an approximately 12-fold higher risk in patients with both IAB and a high CHADS 2 score. Patients meeting these criteria should have more aggressive early intervention to prevent AF. (Int Heart J 2016; 57: 580-585) Key words: Electrocardiogram, Prognosis A trial fibrillation (AF) is a common cardiac arrhythmia in the general population 1) and is associated with an increased risk of death, hospitalization, stroke, and heart failure.2-5) Therefore, it is crucial to identify patients who are at increased risk of developing new onset AF. Interatrial block (IAB) is manifested in the 12-lead electrocardiogram (ECG) by a P-wave duration > 120 ms, 6) and has been associated with increased risk of AF.7-11) Currently, the CHADS 2 score is widely used for predicting future ischemic stroke in patients with AF. 12) Although AF is more prevalent in subjects with high CHADS 2 scores than in those with low CHADS 2 scores, 13,14) the combined role of IAB and the CHADS 2 score in new onset AF in patients in sinus rhythm remains unclear. Therefore, in the present study, we investigated the association of a combination of IAB and high CHADS 2 score on new onset AF in patients in sinus rhythm. MethodsStudy population: Our database of ECG recordings of patients who were hospitalized in Henan Provincial People's Hospital for any therapy between March 1, 2010 and March 15, 2010 was retrospectively reviewed. If patients had more than one ECG recording during the index hospitalization, only the first recording was analyzed to measure P-wave duration, and all of the ECG recordings were analyzed to detect AF. Pwave duration was measured using a resting 12-lead ECG (high-pass filter 0.05 Hz, low-pass filter 150 Hz, 25 mm/s, 10 mm/mv) in all pati...

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Section: Discussionsupporting

confidence: 93%

Usefulness of a Combination of Interatrial Block and a High CHADS<sub>2</sub> Score to Predict New Onset Atrial Fibrillation

Wang

Chu

et al. 2016

Int. Heart J.

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“…Nine publications were excluded, because they were letters to the editor, editorials, or reviews; provided insufficient data; or did not examine the defined end points. Ten studies, including 8 data sets on PTFV1, [1][2][3][8][9][10]22,23 6 data sets on maximum PWD, 1,2,8,9,24,25 and 3 data sets on maximum PWA, 1,8,9 were included in this meta-analysis. [1][2][3][8][9][10][22][23][24][25] The ECG appearances of these indices are depicted in Figure 2.…”

Section: Search Resultsmentioning

confidence: 99%

“…Moreover, AF was not adjusted for in these analyses. By contrast, the pooled meta-analysis of the 3 studies that examined maximum PWD as a categorical variable, 2,24,25 increased maximum PWD conferred a 86% significant increase in stroke risk. Of these studies, Kohsaka et al analyzed outcomes of a cohort of subjects in the Northern Manhattan Stroke Study, demonstrating that prolongations in Figure 6.…”

Section: August 2017mentioning

confidence: 95%

“…36 Second, prolonged PWD occurs when there is abnormal conduction from the sinoatrial node to the left atria, and its presence has been associated with higher stroke risk [37][38][39] and with cardiovascular and all-cause mortality. 24,40 Finally, increases in the maximal PWA, which is the product of the duration and amplitude of the P-wave, are also linked to higher risk of stroke. …”

Section: Discussionmentioning

confidence: 99%

“…A significant relationship was observed when PWD was analyzed as a categorical variable (>110-120 ms; odds ratio, 1.86; 95% CI, 1.37-2.25; P<0.0001) without significant heterogeneity (I 2 =0%; P=0.68; Figure 3B). 2,24,25 PWA has also been proposed as a marker for left atrial abnormality, but limited data on the relationship of maximum PWA and ischemic stroke are available. The pooled analysis of 3 studies 1,8,9 showed that maximum PWA, which was studied as a continuous variable, predicted incident ischemic stroke (OR per 1 SD change, 1.10; 95% CI, 1.04-1.17; P=0.0009) without significant heterogeneity (I 2 =35%; P=0.22; Figure 4).…”

Section: Relationship Between P-wave Terminal Force Pwd or Maximum mentioning

confidence: 99%

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P-Wave Indices and Risk of Ischemic Stroke

Tse

Korantzopoulos

et al. 2017

Stroke

106

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Background and Purpose-Atrial cardiomyopathy is associated with an increased risk of ischemic stroke. P-wave terminal force in lead V 1 , P-wave duration, and maximum P-wave area are electrocardiographic parameters that have been used to assess left atrial abnormalities related to developing atrial fibrillation. The aim of this systematic review and metaanalysis was to examine their values for predicting ischemic stroke risk. Methods-PubMed and EMBASE databases were searched until December 2016 for studies that evaluated the association between P-wave indices and stroke risk. Both fixed-and random-effects models were used to calculate the overall effect estimates. Results-Ten studies examining P-wave terminal force in lead V 1 , P-wave duration, and maximum P-wave area were included. P-wave terminal force in lead V 1 was found to be an independent predictor of stroke as both a continuous Key Words: atrial fibrillation ◼ electrocardiography ◼ heart atria ◼ odds ratio ◼ stroke P-Wave Indices and Risk of Ischemic Stroke

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Other ECG Patterns of Risk

2017

Clinical Arrhythmology

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Interatrial Block: A Novel Risk Factor for Embolic Stroke?

Abstract: IAB could indeed be a novel risk for embolic strokes and further investigation is warranted.

Cited by 64 publications

References 16 publications

Usefulness of a Combination of Interatrial Block and a High CHADS<sub>2</sub> Score to Predict New Onset Atrial Fibrillation

Usefulness of a Combination of Interatrial Block and a High CHADS<sub>2</sub> Score to Predict New Onset Atrial Fibrillation

P-Wave Indices and Risk of Ischemic Stroke

Other ECG Patterns of Risk

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