Interatrial block, P terminal force or fragmented QRS do not predict new-onset atrial fibrillation in patients with severe chronic kidney disease

Abstract

Background The prevalence of left atrial enlargement (LAE) and fragmented QRS (fQRS) diagnosed using ECG criteria in patients with severe chronic kidney disease (CKD) is unknown. Furthermore, there is limited data on predicting new-onset atrial fibrillation (AF) with LAE or fQRS in this patient group. Methods We enrolled 165 consecutive non-dialysis patients with CKD stage 4–5 without prior AF diagnosis between 2013 and 2017 in a prospective follow-up cohort study. LAE was defined as total P-wave duration ≥120 ms in lead II ± > 1 biphasic P-waves in leads II, III or aVF; or duration of terminal negative portion of P-wave > 40 ms or depth of terminal negative portion of P-wave > 1 mm in lead V1 from a baseline ECG, respectively. fQRS was defined as the presence of a notched R or S wave or the presence of ≥1 additional R waves (R’) or; in the presence of a wide QRS complex (> 120 ms), > 2 notches in R or S waves in two contiguous leads corresponding to a myocardial region, respectively. Results Mean age of the patients was 59 (SD 14) years, 56/165 (33.9%) were female and the mean estimated glomerular filtration rate was 12.8 ml/min/1.73m2. Altogether 29/165 (17.6%) patients were observed with new-onset AF within median follow-up of 3 [IQR 3, range 2–6] years. At baseline, 137/165 (83.0%) and 144/165 (87.3%) patients were observed with LAE and fQRS, respectively. Furthermore, LAE and fQRS co-existed in 121/165 (73.3%) patients. Neither findings were associated with the risk of new-onset AF within follow-up. Conclusion The prevalence of LAE and fQRS at baseline in this study on CKD stage 4–5 patients not on dialysis was very high. However, LAE or fQRS failed to predict occurrence of new-onset AF in these patients.

ECG predictors of AF: A systematic review (predicting AF in ischaemic stroke-PrAFIS)

“…IAB was found to be predictive of AF in a sub analysis that excluded obese patients. Another study including only patients with CKD stage IV or V found both aIAB and PTFV1 to not be significant predictors of AF (60).…”

Electrocardiographic Predictors of Atrial Fibrillation

“…Out of the fifteen studies, thirteen reported that the presence of A-IAB was associated with AF, whilst only two studies failed to demonstrate such an association. The first one included 165 patients with chronic kidney disease (CKD) at stage 4 or 5, while the second one involved 240 healthy Italians aged 25–79 years [ 17 , 22 ].…”

Interatrial Block, Bayés Syndrome, Left Atrial Enlargement, and Atrial Failure

“…This association has been demonstrated in several clinical scenarios including heart failure, ischemic heart disease, Takotsubo syndrome, transcatheter aortic valve implantation, cardiac amyloidosis, sleep apnea, cavotricuspid isthmus and pulmonary vein ablation, and following electrical/pharmacological cardioversion [32][33][34][35][36][37][38]. However, the predictive power of IAB appears to be lower in other situations, such as severe chronic kidney disease [39]. IAB is also associated with stroke risk [40] and this association is independent of the presence of AF [41] as could be expected due to the aforementioned fibrotic atriopathy that causes electromechanical dissociation.…”