title: Advanced Interatrial Block Predicts New Onset Atrial Fibrillation in Patients with Severe Heart Failure and Cardiac Resynchronization Therapy.
abstract: BACKGROUND
  Advanced interatrial block (aIAB) on the surface electrocardiogram (ECG), defined as a P-wave duration ≥120 milliseconds with biphasic (±) morphology in inferior leads, is frequently associated with atrial fibrillation (AF). The aim of this study was to determine whether preoperative aIAB could predict new-onset AF in patients with severe congestive heart failure (CHF) requiring cardiac resynchronization therapy (CRT).
  
  
  METHODS
  Retrospective analysis of consecutive patients with CHF and no prior history of AF undergoing CRT for standard indications. A baseline 12-lead ECG was obtained prior to device implantation and analyzed for the presence of aIAB. ECGs were scanned at 300 DPI and maximized 8×. Semiautomatic calipers were used to determine P-wave onset and offset. The primary outcome was the occurrence of AF identified through analyses of intracardiac electrograms on routine device follow-up.
  
  
  RESULTS
  Ninety-seven patients were included (74.2% male, left atrial diameter 45.5 ± 7.8 mm, 63% ischemic). Mean P-wave duration was 138.5 ± 18.5 milliseconds and 37 patients (38%) presented aIAB at baseline. Over a mean follow-up of 32 ± 18 months, AF was detected in 29 patients (30%) and the incidence was greater in patients with aIAB compared to those without it (62% vs 28%; P < 0.003). aIAB remained a significant predictor of AF occurrence after multivariate analysis (OR 4.1; 95% CI, 1.6-10.7; P < 0.003).
  
  
  CONCLUSIONS
  The presence of aIAB is an independent predictor of new-onset AF in patients with severe CHF undergoing CRT.
authors: Division of Cardiology, Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
authors: Fariha
authors: F
authors: Sadiq Ali
authors: Division of Cardiology, Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
authors: Andres
authors: A
authors: Enriquez
authors: Cardiovascular Institute of Buenos Aires, Buenos Aires, Argentina.
authors: Diego
authors: D
authors: Conde
authors: Division of Cardiology, Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
authors: Damian
authors: D
authors: Redfearn
authors: Division of Cardiology, Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
authors: Kevin
authors: K
authors: Michael
authors: Division of Cardiology, Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
authors: Christopher
authors: C
authors: Simpson
authors: Division of Cardiology, Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
authors: Hoshiar
authors: H
authors: Abdollah
authors: Division of Cardiology, Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.|Hospital of Santa Creu i Sant Pau, Cardiovascular Research Center, CSIC-ICCC, Barcelona, Spain.
authors: Antoni
authors: A
authors: Bayés de Luna
authors: Division of Cardiology, Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
authors: Wilma
authors: W
authors: Hopman
authors: Division of Cardiology, Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
authors: Adrian
authors: A
authors: Baranchuk
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis*; D058406:Cardiac Resynchronization Therapy; D004562:Electrocardiography; D005260:Female; D006327:Heart Block / Q000150:complications / Q000175:diagnosis*; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: atrial fibrillation; cardiac resynchronization; heart failure; interatrial block
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