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Association of interatrial block with development of atrial fibrillation
Association of Interatrial Block With Development of Atrial Fibrillation Yogesh K. Agarwal,
MD,
Wilbert S. Aronow, MD, James A. Levy, David H. Spodick, MD
nteratrial block (IAB) is mainly considered to be an electric abnormality of the Bachmann bundle that Idelays activation of the left atrium. IAB is manifest 1
on a surface electrocardiogram as prolonged P-wave duration (ⱖ110 ms).2 During a 30-month follow-up of 16 patients with IAB, 8 patients (50%) developed atrial fibrillation (AF).3 We are reporting the prevalence of IAB in 308 patients in a general hospital population who developed AF at 16-month follow-up and the prevalence of IAB in 308 age-matched and gender-matched control patients who remained in sinus rhythm at 16-month follow-up. •••
The P-wave duration was measured in leads II, aVF, and V1 in the last 12-lead electrocardiogram of 141 women and 167 men (mean age 74 ⫾ 9 years, range 26 to 93) in a general hospital population randomly selected with sinus rhythm who developed AF on the next electrocardiogram. The duration between sinus rhythm and AF was 16 ⫾ 23 months (range 1 day to 6.1 years). The P-wave duration was also measured in leads II, aVF, and V1 in a 12-lead electrocardiogram of 143 women and 165 men (mean age 74 ⫾ 9 years, range 31 to 89) in a general hospital population randomly selected with sinus rhythm who remained in sinus rhythm at 16 ⫾ 23 months of follow-up (range 1 day to 6.2 years). IAB was diagnosed if the P-wave duration was ⱖ110 ms in any of the 3 electrocardiographic leads measured. Chi-square analysis was used to analyze our data. Table 1 indicates that IAB was present in 160 of 308 patients (52%) who developed AF and in 56 of 308 patients (18%) who remained in sinus rhythm (p ⬍0.0001). The maximal P-wave duration in patients with IAB ranged from 110 to 200 ms in patients who developed AF and from 110 to 140 ms in patients who remained in sinus rhythm. ••• From the Cardiology Division, Westchester Medical Center/New York Medical College, Valhalla, New York; and the Cardiovascular Division, Saint Vincent Hospital and Worcester Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts. Dr. Aronow’s address is: Cardiology Division, New York Medical College, Macy Pavilion, Room 138, Valhalla, New York 10595. E-mail: [email protected]. Manuscript received and accepted December 2, 2002.
882
©2003 by Excerpta Medica, Inc. All rights reserved. The American Journal of Cardiology Vol. 91 April 1, 2003
MD,
and
TABLE 1 Prevalence of Interatrial Block (IAB) in 308 Patients Who Developed Atrial Fibrillation (AF) at 16 ⫾ 23 Months of Follow-up and in 308 Age-matched and Gender-matched Patients Who Remained in Sinus Rhythm at 16 ⫾ 23 Months of Follow-up
Prevalence of IAB
AF Group (n ⫽ 308)
Sinus Rhythm Group (n ⫽ 308)
p Value
160 (52%)
56 (18%)
⬍0.0001
Jairath and Spodick4 found that IAB was present in 328 of 797 patients (41%) with sinus rhythm in a general hospital population. IAB was more common in men than in women and was more common in patients ⬎60 years than in younger patients.4 In a study of 24 patients with and 16 patients without IAB, Goyal and Spodick5 demonstrated that patients with IAB have a sluggish, poorly contractile left atrium, and that the extent of left atrial dysfunction was related to the degree of electric delay from IAB. These investigators considered IAB a risk factor for AF.5 During a 30-month follow-up of 16 patients with IAB, 8 patients (50%) developed AF.3 In the present report, the prevalence of IAB was 52% of 308 patients who developed AF at 16-month follow-up and 18% of 308 age-matched and gendermatched control patients who remained in sinus rhythm at 16-month follow-up (p <0.0001). These data show that IAB diagnosed from a 12-lead electrocardiogram is associated with a high incidence of subsequent AF. 1. Waldo AL, Bush HL, Gelband H, Zorn GL Jr, Vitikianen KJ, Hoffman BF.
Effects on the canine P wave of discrete lesions in the specialized atrial tracts. Circ Res 1971;29:452–461. 2. Willems JL, Demedina BO, Bernard R, Coumel P, Fisch C, Krikler D, Mazur NA, Meijler FL, Morgensen L, Moret P. World Health Organization International Society and Federation of Cardiology Task Force criteria for intraventricular conduction disturbances and preexcitation. J Am Coll Cardiol 1985;5:1261–1275. 3. Bayes de Luna A, Cladellas M, Oter R, Torner P, Guindo J, Marti V, Rivera I, Iturralde P. Interatrial conduction block and retrograde activation of the left atrium and paroxysmal supraventricular tachyarrhythmia. Eur Heart J 1988;9: 1112–1118. 4. Jairath UC, Spodick DH. Exceptional prevalence of interatrial block in a general hospital population. Clin Cardiol 2001;24:548 –550. 5. Goyal SB, Spodick DH. Electromechanical dysfunction of the left atrium associated with interatrial block. Am Heart J 2001;142:823–827.
0002-9149/03/$–see front matter doi:10.1016/S0002-9149(03)00027-4
MD,
Wilbert S. Aronow, MD, James A. Levy, David H. Spodick, MD
nteratrial block (IAB) is mainly considered to be an electric abnormality of the Bachmann bundle that Idelays activation of the left atrium. IAB is manifest 1
on a surface electrocardiogram as prolonged P-wave duration (ⱖ110 ms).2 During a 30-month follow-up of 16 patients with IAB, 8 patients (50%) developed atrial fibrillation (AF).3 We are reporting the prevalence of IAB in 308 patients in a general hospital population who developed AF at 16-month follow-up and the prevalence of IAB in 308 age-matched and gender-matched control patients who remained in sinus rhythm at 16-month follow-up. •••
The P-wave duration was measured in leads II, aVF, and V1 in the last 12-lead electrocardiogram of 141 women and 167 men (mean age 74 ⫾ 9 years, range 26 to 93) in a general hospital population randomly selected with sinus rhythm who developed AF on the next electrocardiogram. The duration between sinus rhythm and AF was 16 ⫾ 23 months (range 1 day to 6.1 years). The P-wave duration was also measured in leads II, aVF, and V1 in a 12-lead electrocardiogram of 143 women and 165 men (mean age 74 ⫾ 9 years, range 31 to 89) in a general hospital population randomly selected with sinus rhythm who remained in sinus rhythm at 16 ⫾ 23 months of follow-up (range 1 day to 6.2 years). IAB was diagnosed if the P-wave duration was ⱖ110 ms in any of the 3 electrocardiographic leads measured. Chi-square analysis was used to analyze our data. Table 1 indicates that IAB was present in 160 of 308 patients (52%) who developed AF and in 56 of 308 patients (18%) who remained in sinus rhythm (p ⬍0.0001). The maximal P-wave duration in patients with IAB ranged from 110 to 200 ms in patients who developed AF and from 110 to 140 ms in patients who remained in sinus rhythm. ••• From the Cardiology Division, Westchester Medical Center/New York Medical College, Valhalla, New York; and the Cardiovascular Division, Saint Vincent Hospital and Worcester Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts. Dr. Aronow’s address is: Cardiology Division, New York Medical College, Macy Pavilion, Room 138, Valhalla, New York 10595. E-mail: [email protected]. Manuscript received and accepted December 2, 2002.
882
©2003 by Excerpta Medica, Inc. All rights reserved. The American Journal of Cardiology Vol. 91 April 1, 2003
MD,
and
TABLE 1 Prevalence of Interatrial Block (IAB) in 308 Patients Who Developed Atrial Fibrillation (AF) at 16 ⫾ 23 Months of Follow-up and in 308 Age-matched and Gender-matched Patients Who Remained in Sinus Rhythm at 16 ⫾ 23 Months of Follow-up
Prevalence of IAB
AF Group (n ⫽ 308)
Sinus Rhythm Group (n ⫽ 308)
p Value
160 (52%)
56 (18%)
⬍0.0001
Jairath and Spodick4 found that IAB was present in 328 of 797 patients (41%) with sinus rhythm in a general hospital population. IAB was more common in men than in women and was more common in patients ⬎60 years than in younger patients.4 In a study of 24 patients with and 16 patients without IAB, Goyal and Spodick5 demonstrated that patients with IAB have a sluggish, poorly contractile left atrium, and that the extent of left atrial dysfunction was related to the degree of electric delay from IAB. These investigators considered IAB a risk factor for AF.5 During a 30-month follow-up of 16 patients with IAB, 8 patients (50%) developed AF.3 In the present report, the prevalence of IAB was 52% of 308 patients who developed AF at 16-month follow-up and 18% of 308 age-matched and gendermatched control patients who remained in sinus rhythm at 16-month follow-up (p <0.0001). These data show that IAB diagnosed from a 12-lead electrocardiogram is associated with a high incidence of subsequent AF. 1. Waldo AL, Bush HL, Gelband H, Zorn GL Jr, Vitikianen KJ, Hoffman BF.
Effects on the canine P wave of discrete lesions in the specialized atrial tracts. Circ Res 1971;29:452–461. 2. Willems JL, Demedina BO, Bernard R, Coumel P, Fisch C, Krikler D, Mazur NA, Meijler FL, Morgensen L, Moret P. World Health Organization International Society and Federation of Cardiology Task Force criteria for intraventricular conduction disturbances and preexcitation. J Am Coll Cardiol 1985;5:1261–1275. 3. Bayes de Luna A, Cladellas M, Oter R, Torner P, Guindo J, Marti V, Rivera I, Iturralde P. Interatrial conduction block and retrograde activation of the left atrium and paroxysmal supraventricular tachyarrhythmia. Eur Heart J 1988;9: 1112–1118. 4. Jairath UC, Spodick DH. Exceptional prevalence of interatrial block in a general hospital population. Clin Cardiol 2001;24:548 –550. 5. Goyal SB, Spodick DH. Electromechanical dysfunction of the left atrium associated with interatrial block. Am Heart J 2001;142:823–827.
0002-9149/03/$–see front matter doi:10.1016/S0002-9149(03)00027-4