Prognostic of Interatrial Block after an Acute ST-Segment Elevation Myocardial Infarction

Abstract

Background: The influence of interatrial block (IAB) in the prognosis after an acute ST-segment elevation myocardial infarction (STEMI) is unknown. Objectives: To assess the prognostic impact of IAB after an acute STEMI regarding long-term mortality, development of atrial fibrillation, and stroke. Methods: Registry of 972 consecutive patients with STEMI and sinus rhythm at discharge, with a long-term follow-up (49.6 ± 24.9 months). P wave duration was analyzed using digital calipers, and patients were divided into three groups: normal P wave duration (<120 ms), partial IAB (pIAB) (P wave ≥120 ms and positive in inferior leads), and advanced IAB (aIAB) (P wave ≥120 ms plus biphasic [positive/negative] morphology in inferior leads). Results: Mean age was 62.6 ± 13.5 years. A total of 708 patients had normal P wave (72.8%), 207 pIAB (21.3%), and 57 aIAB (5.9%). Patients with aIAB were older (mean age 73 years) than the rest (62 years in the other two groups, p < 0.001). They also had a higher rate of hypertension (70 vs. 55% in pIAB and 49% in normal P wave, p = 0.006) and higher all-cause mortality (26.3 vs. 12.6% in pIAB and 10.3% in normal P wave, p = 0.001). However, multivariable analysis did not show an independent association between IAB and prognosis. Conclusion: About a quarter of patients discharged in sinus rhythm after an acute STEMI have IAB. Patients with aIAB have a poor prognosis, although this is explained mainly by the association of aIAB with age and other variables.

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.…”

Conduction Disorders in the Setting of Acute STEMI

“…Partial IAB on admission and six hours post-PCI were independent predictors of atrial fibrillation at 12-month follow-up. In a registry study (n=972) of STEMI patients in sinus rhythm at hospital discharge, 21.3% had partial and 5.9% advanced IAB [9]. Patients with IAB had higher all-cause mortality than patients without IAB, but the association was explained by older age and other variables, while the multivariable analysis did not show any independent association between IAB and prognosis.…”