Clinician underappreciation of interatrial block in a general hospital population.
BACKGROUND
Interatrial block (IAB; P wave > or =110 ms), a conduction delay between the right and left atria (LA), is highly prevalent and strongly associated with atrial tachyarrhythmias, LA electromechanical dysfunction as well as a risk of embolism. Nonetheless, clinicians' underappreciation of its existence and sequelae remains. We appraised this issue in a general hospital population.


METHODS
From the database of 730 12-lead electrocardiograms (ECGs) of patients aged 17-98 years (mean age 67.80 years; female patients 53.56%) in a tertiary care teaching general hospital, we recorded the computer-generated diagnostic readings of the ECGs and also the official cardiologist and hospitalist ECG interpretations and documentations. For increased sensitivity and specificity, and because the mode P wave duration in IAB is 120 ms, P waves > or =120 ms in any lead were used to diagnose IAB.


RESULTS
Six hundred and fifty-three ECGs (89.45%) showed sinus rhythm, and of those, IAB was documented on 309 ECGs (47.32%). LA enlargement was cited 29 times (3.97%), while possible LA enlargement and biatrial enlargement were cited 17 (2.32%) and 6 times (0.82%), respectively. One cardiologist's ECG interpretation documented IAB (0.32%), but none of the other medical staff diagnosed IAB or abnormal P wave duration.


CONCLUSIONS
This study demonstrates to extremes how IAB went undiagnosed in a general hospital population. Until more awareness of IAB is cultivated, such ignorance of the existence and sequelae of IAB could continue. Configuring ECG software to include P wave durations in computer-generated ECG readings could be useful in aiding diagnosis.
Ariyarajah
Vignendra
V
Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Healthcare System, Boston, Mass., USA.
Puri
Puneet
P
Spodick
David H
DH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004562:Electrocardiography; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006325:Heart Atria / Q000473:pathology; D006327:Heart Block / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology*; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted