Interatrial Block Predicts Atrial Fibrillation and Total Mortality in Patients with Cardiac Resynchronization Therapy

摘要

Background: Interatrial block (IAB) and abnormal P-wave terminal force in lead V_(1) (PTFV_(1)) are electrocardiographic (ECG) abnormalities that have been shown to be associated with new-onset atrial fibrillation (AF) and death. However, their prognostic importance has not been proven in cardiac resynchronization therapy (CRT) recipients. Objective: To assess if IAB and abnormal PTFV_(1) are associated with new-onset AF or death in CRT recipients. Methods: CRT recipients with sinus rhythm ECG at CRT implantation and no AF history were included ( n = 210). Automated analysis of P-wave duration (PWD) and morphology classified patients as having either no IAB (PWD 0.04 mm?s was considered abnormal. Adjusted Cox regression analyses were performed to assess the impact of IAB and abnormal PTFV_(1) on the primary endpoint new-onset AF, death, or heart transplant (HTx) and the secondary endpoint death or HTx at 5 years of follow-up. Results: IAB was found in 45% of all patients and independently predicted the primary endpoint with HR 1.9 (95% CI 1.2–2.9, p = 0.004) and the secondary endpoint with HR 2.1 (95% CI 1.2–3.4, p = 0.006). Abnormal PTFV_(1) was not associated with the endpoints. Conclusions: IAB is associated with new-onset AF and death in CRT recipients and may be helpful in the risk stratification in the context of heart failure management. Abnormal PTFV_(1) did not demonstrate any prognostic value.