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Istolahti T, Eranti A, Huhtala H, Lyytikäinen LP, Kähönen M, Lehtimäki T, Eskola M, Anttila I, Jula A, Bayés de Luna A, Nikus K, Hernesniemi J. The prevalence and prognostic significance of interatrial block in the general population. Ann Med 2020; 52:63-73. [PMID: 32077319 PMCID: PMC7877939 DOI: 10.1080/07853890.2020.1731759] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Introduction: Partial and advanced interatrial block (IAB) in the electrocardiographic (ECG) represents inter-atrial conduction delay. IAB is associated with atrial fibrillation (AF) and stroke in the general population.Material and methods: A representative sample of Finnish subjects (n = 6354) aged over 30 years (mean: 52.2 years, standard deviation: 14.6) underwent a health examination including a 12-lead ECG. Five different IAB groups based on automatic measurements were compared to normal P waves using multivariate-adjusted Cox proportional hazard model. Follow-up lasted up to 15 years.Results: The prevalence of advanced and partial IAB was 1.0% and 9.7%, respectively. In the multivariate model, both advanced (hazard ratio (HR): 1.63 (95% confidence interval (CI): 1.00-2.65)) and partial IAB (HR: 1.39 (1.09-1.77)) were associated with increased risk of AF. Advanced IAB was associated with increased risk of stroke or transient ischaemic attack (TIA) independently of associated AF (HR: 2.22 (1.20-4.13)). Partial IAB was also associated with increased risk of being diagnosed with coronary heart disease (HR: 1.26 (1.01-1.58)).Discussion: IAB is a rather frequent finding in the general population. IAB is a risk factor for AF and is associated with an increased risk of stroke or TIA independently of associated AF.Key messagesBoth partial and advanced interatrial block are associated with increased risk of atrial fibrillation in the general population.Advanced interatrial block is an independent risk factor for stroke and transient ischaemic attack.The clinical significance of interatrial block is dependent on the subtype classification.
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Affiliation(s)
- Tiia Istolahti
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Finland.,Department of Internal Medicine, Vaasa Central Hospital, Vaasa, Finland
| | - Antti Eranti
- Heart Center, Central Hospital of North Karelia, Joensuu, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Leo-Pekka Lyytikäinen
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Finland.,Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland.,Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Finland.,Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Terho Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Finland.,Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
| | - Markku Eskola
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Finland.,Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Ismo Anttila
- Department of Emergency Services, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Antti Jula
- National Institute for Health and Welfare, Helsinki, Finland
| | - Antoni Bayés de Luna
- Cardiovascular Research Foundation, Cardiovascular ICCC-Program, Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Kjell Nikus
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Finland.,Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University and Finnish Cardiovascular Research Center, Tampere, Finland.,Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
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Seoane L, Cortés M, Conde D. Update on Bayés' syndrome: the association between an interatrial block and supraventricular arrhythmias. Expert Rev Cardiovasc Ther 2019; 17:225-235. [PMID: 30715961 DOI: 10.1080/14779072.2019.1577137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The past few years have given rise to extensive research on an interatrial block and its clinical relevance, mainly its association with supraventricular arrhythmias. In 2015, the authors of this article reviewed the Bayes syndrome for the first time and after three years there has been so much evidence accumulated that it seems reasonable to rewrite an update, based fundamentally on the new findings. Focused on its relationship with cardioembolic strokes, today efforts are being targeted at understanding its pathophysiology, its diagnosis, and its prognostic implications, in order to learn if it should be treated. Areas covered: A non-systematic review of the literature was developed using the Pubmed and Cochrane databases, focusing on randomized clinical trials and large observational studies that evaluated new physiopathological and epidemiological aspects, new clinical scenarios in which it has been assessed and its association with dementia. Finally, those studies that proposed new possible treatments were reviewed. Expert commentary: Interatrial block is not only a predictor of supraventricular arrhythmias, is a subclinical disease that might be considered as a marker of risk for adverse outcomes. Although there is some evidence to suggest that early treatment may be beneficial, potential therapies have yet to be investigated.
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Affiliation(s)
- Leonardo Seoane
- a Department of Cardiology , Instituto Cardiovascular de Buenos Aires , Buenos Aires , Argentina
| | - Marcia Cortés
- a Department of Cardiology , Instituto Cardiovascular de Buenos Aires , Buenos Aires , Argentina
| | - Diego Conde
- a Department of Cardiology , Instituto Cardiovascular de Buenos Aires , Buenos Aires , Argentina
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Hernandez-Betancor I, Izquierdo-Gómez MM, García-Niebla J, Laynez-Cerdeña I, García-González MJ, Irribarren-Sarriá JL, Jimenez-Rivera JJ, Lacalzada-Almeida J. Bayes Syndrome and Imaging Techniques. Curr Cardiol Rev 2017; 13:263-273. [PMID: 28707575 PMCID: PMC5730959 DOI: 10.2174/1573403x13666170713122600] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 06/23/2017] [Accepted: 07/03/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Interatrial block (IAB) is due to disruption in the Bachmann region (BR). According to whether interatrial electrical conduction is delayed or completely blocked through the BR, it can be classified as IAB of first, second or third degree. On the surface electrocardiogram, a P wave ≥ 120 ms (partial IAB) is observed or associated to the prolongation of the P wave with a biphasic (positive / negative) morphology in the inferior leads (advanced IAB). Bayes syndrome is defined as an advanced IAB associated with atrial arrhythmia, more specifically atrial fibrillation. Objective and Conclusion: The purpose of this review is to describe the latest evidence about an entity considered an anatomical and electrical substrate with its own name, which may be a predictor of supraventricular arrhythmia and cardioembolic cerebrovascular accidents, as well as the role of new imaging techniques, such as echocardiographic strain and cardiac magnetic resonance imaging, in characterizing atrial alterations associated with this syndrome and generally in the study of anatomy and atrial function.
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Affiliation(s)
- Iván Hernandez-Betancor
- Departamento de Cardiología, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, España
| | | | - Javier García-Niebla
- Centro de Salud Valle del Golfo, Servicios Sanitarios del Área de Salud de El Hierro, Frontera-El Hierro, Santa Cruz de Tenerife, Tenerife, España
| | - Ignacio Laynez-Cerdeña
- Departamento de Cardiología, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, España
| | | | - Barragan-Acea
- Departamento de Cardiología, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, España
- Centro de Salud Valle del Golfo, Servicios Sanitarios del Área de Salud de El Hierro, Frontera-El Hierro, Santa Cruz de Tenerife, Tenerife, España
- Departamento de Unidad de Cuidados Intensivos, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, España
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- Departamento de Cardiología, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, España
| | - Jose Luis Irribarren-Sarriá
- Departamento de Unidad de Cuidados Intensivos, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, España
| | - Juan José Jimenez-Rivera
- Departamento de Unidad de Cuidados Intensivos, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, España
| | - Juan Lacalzada-Almeida
- Departamento de Cardiología, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, España
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Chhabra L, Devadoss R, Chaubey VK, Spodick DH. Interatrial block in the modern era. Curr Cardiol Rev 2014; 10:181-9. [PMID: 24827803 PMCID: PMC4040870 DOI: 10.2174/1573403x10666140514101748] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 01/25/2013] [Accepted: 01/28/2014] [Indexed: 12/13/2022] Open
Abstract
Interatrial block (IAB; P-wave duration ≥ 110 ms), which represents a delay in the conduction between the atria, is a pandemic conduction abnormality that is frequently underappreciated in clinical practice. Despite its comprehensive documentation in the medical literature, it has still not received adequate attention and also not adequately described and discussed in most cardiology textbooks. IAB can be of varying degrees and classified based on the degree of P-duration and its morphology. It can transform into a higher degree block and can also manifest transiently. IAB may be a preceding or causative risk factor for various atrial arrhythmias (esp. atrial fibrillation) and also be associated with various other clinical abnormalities ranging from left atrial dilation and thromboembolism including embolic stroke and mesenteric ischemia. IAB certainly deserves more attention and prospective studies are needed to formulate a standard consensus regarding appropriate management strategies.
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Kitkungvan D, Spodick DH. Interatrial block: is it time for more attention? J Electrocardiol 2009; 42:687-92. [PMID: 19698951 DOI: 10.1016/j.jelectrocard.2009.07.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Indexed: 10/20/2022]
Abstract
Interatrial block (IAB) is defined as delayed conduction between the right and left atrium, which results in prolonged P-wave duration (> or =110 milliseconds). Interatrial block can be partial or advanced (much less common), depending on the severity of the conduction abnormality. Several studies have reported that the prevalence of IAB is more than 40% in hospital inpatients. Despite this, IAB remains largely underdiagnosed and commonly ignored. Although more investigations are needed to identify the cause of IAB, coronary artery disease and conditions related to cardiovascular disease, such as hypertension or diabetes mellitus, have been described as potential risk factors for developing IAB. Interatrial block has strong associations with multiple medical conditions including atrial fibrillation, myocardial ischemia, left atrial enlargement, and systemic emboli. Treatment modalities for IAB to preclude its consequences include pacing and medical management, in which angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have given promising results. However, more interest, attention, and research for IAB is required to explore this uncertain issue thoroughly.
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Affiliation(s)
- Danai Kitkungvan
- Department of Medicine, Saint Vincent Hospital, Worcester, MA 01608, USA.
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Spodick DH, Ariyarajah V. Interatrial block: the pandemic remains poorly perceived. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:667-72. [PMID: 19422591 DOI: 10.1111/j.1540-8159.2009.02343.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Interatrial block (IAB; P duration >or=110 ms) is a common electrocardiogram abnormality, which in addition to reduced left atrial function predicts atrial fibrillation and other arrhythmias. P terminal force (Ptf) +/- biphasic P in lead V(1)>or= the area of one small square on the grid also indicates left atrial abnormality, particularly left atrial enlargement, which is a strong correlate of IAB. Among 482 consecutively recorded electrocardiograms, IAB and Ptf were strongly and significantly correlated (chi(2)= 68.041; P <or= 0.001).In conclusion, interatrial block exists in pandemic proportions in unselected hospital patients. Because of its pathologic implications it requires widespread attention which, heretofore, has been lacking.
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Affiliation(s)
- David H Spodick
- University of Massachusetts Medical School, Worcester, Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts 01608, USA.
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Prajapat L, Ariyarajah V, Spodick DH. Induction of Atrial Depolarization Abnormality during Dipyridamole Stress Imaging: A Cautionary Note. Cardiology 2008; 110:35-8. [DOI: 10.1159/000109404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Accepted: 04/19/2007] [Indexed: 11/19/2022]
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Ariyarajah V, Spodick DH, Fernandes J, Apiyasawat S. Limited utility of interatrial block in predicting ischemia on coronary angiography in patients with suboptimal exercise performance. Int J Cardiol 2007; 119:334-8. [PMID: 17045665 DOI: 10.1016/j.ijcard.2006.07.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Revised: 07/17/2006] [Accepted: 07/29/2006] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Interatrial block (P waves > or = 110 ms) is thought to be associated with underlying myocardial ischemia during exercise but has not been extensively investigated in patients with suboptimal or borderline exercise tolerance tests (< 3 min exercise). We utilized coronary angiography to assess the relationship of both, the resting baseline and exercise induced increase in P-wave duration with coronary artery disease among patients who had undergone such tests. METHODS We prospectively identified 51 consecutive patients with interatrial block who had coronary artery disease and hypertension but not atrioventricular valvular heart disease, and had undergone coronary angiography to evaluate myocardial ischemia after a suboptimal exercise tolerance test. A control group of 64 consecutive exercise tolerance test patients with similar preliminary characteristics but without interatrial block at rest was used for comparison. Patients from both groups were then appraised for significant obstructive lesions (> 70%) on coronary angiography that were suggestive of myocardial ischemia. RESULTS Obstructive coronary artery lesions suggestive of myocardial ischemia were more frequent among interatrial block patients but this was not statistically significant (p=0.25). However, change in P-wave duration of > 20 ms occurred more frequently in interatrial block patients in the presence of a positive exercise tolerance test. Among patients without interatrial block at baseline, more patients who developed new interatrial block had significant disease on coronary angiography. CONCLUSION The utility of using interatrial block toward predicting myocardial ischemia among patients with suboptimal exercise tolerance tests is limited. However, further investigation on the early change in P-wave duration in patients with interatrial block and the development of new interatrial block during exercise could be helpful in optimizing exercise tolerance tests, particularly when borderline or suboptimal.
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Affiliation(s)
- Vignendra Ariyarajah
- Preventive Cardiology, Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Healthcare System, 150 South Huntington Avenue, Boston, Massachusetts 02130, USA.
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Ariyarajah V, Apiyasawat S, Fernandes J, Kranis M, Spodick DH. Association of atrial fibrillation in patients with interatrial block over prospectively followed controls with comparable echocardiographic parameters. Am J Cardiol 2007; 99:390-2. [PMID: 17261404 DOI: 10.1016/j.amjcard.2006.08.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Revised: 08/10/2006] [Accepted: 08/10/2006] [Indexed: 12/19/2022]
Abstract
Interatrial block (IAB) (P wave >or=110 ms) is a potential risk of atrial fibrillation (AF). However, few investigations have assessed the relevance of echocardiographic parameters, particularly the contribution of its known correlate, left atrial enlargement in this regard. We identified 32 consecutive patients with comparable echocardiographic parameters, such as left atrial dimension and left ventricular ejection fraction. Patients were evaluated for IAB and followed for 15 months for cardiovascular events (heart failure, transient ischemic attacks, and stroke), atrial tachyarrhythmias (AF/atrial flutter), and death. Preexisting AF and IAB (p = 0.02) were significantly associated with future AF events. However, logistic regression analysis indicated that IAB was not an independent predictor of future AF, only preexisting atrial tachyarrhythmias was (hazard ratio 39.5, 95% confidence interval 2.7 to 576.3, p = 0.007). In conclusion, in patients with comparable echocardiographic parameters, such as left atrial size and left ventricular ejection fraction, IAB remained associated with AF after a 15-month follow-up. Additional investigation is needed to confirm the extent of the association.
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Affiliation(s)
- Vignendra Ariyarajah
- Division of Cardiology, Department of Medicine, St. Boniface General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada.
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Ariyarajah V, Apiyasawat S, Spodick DH. Association of Duke prognostic treadmill scores with change in P-wave duration during exercise tolerance tests in patients with interatrial block and coronary heart disease. Am J Cardiol 2006; 98:786-8. [PMID: 16950185 DOI: 10.1016/j.amjcard.2006.04.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Revised: 04/12/2006] [Accepted: 04/12/2006] [Indexed: 11/18/2022]
Abstract
Interatrial block (IAB), as denoted by P waves > or =110 ms in duration, is believed to be associated with underlying ischemia, particularly with that of its principal interatrial conduction pathway, the Bachmann bundle. In this study, the association between Duke prognostic treadmill (DPT) scores and change in P-wave duration in IAB was investigated in patients who underwent cardiopulmonary exercise tolerance tests (CPETTs). Twenty-seven patients with IAB and 42 control patients without IAB on electrocardiography at rest who had evidence of myocardial ischemia on coronary angiography after CPETTs were identified consecutively. P-wave measurements were obtained independently at the beginning of every CPETT stage and also when P-wave changes occurred. Increments in P-wave durations were measured to the nearest 20 ms. DPT scores were calculated for the 2 groups. There was no significant difference between the groups in mean values for DPT scores and for exercise capacity. However, change in P-wave duration in patients with IAB was significantly associated with mean DPT score. As the change in P-wave duration increased, the DPT score was significantly less (p = 0.003). DPT scores were more significant with P-wave changes of >20 ms compared with P-wave changes of < or =20 ms (p = 0.00001). In conclusion, in patients with coronary heart disease and IAB at rest, increases in P-wave durations during CPETTs are inversely associated with DPT scores.
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Affiliation(s)
- Vignendra Ariyarajah
- Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.
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