Abstract
The presence of an interatrial block (IAB) on surface ECG should be considered as a hallmark of atrial electrical remodelling. This is often accompanied by morphological abnormalities. We aimed to investigate the frequency of IAB and its relationship with the echocardiographic indices of left atrial (LA) remodelling in patients hospitalised with acute HF. Ninety-four consecutive HF patients underwent 12-lead ECG, transthoracic echocardiogram including a detailed study of the LA, and blood tests (including NT-proBNP) on the same day. Thirty-six patients were excluded from the analysis because of atrial fibrillation or rhythms other than sinus. Twenty-eight over 58 (48%) were males. Median age was 72 (IQR 60–82) years. The majority of patients (72%) were diagnosed as having an HF with reduced ejection fraction. Overall, 27 (46%) patients presented with an advanced III or IV NYHA functional class. Median plasma NT-proBNP was 3046 (IQR 1066–5460) pg/ml. Nearly, all the enrolled patients (90%) showed LA dilation. Nineteen patients (33%) presented with advanced IAB. There was a trend toward a more advanced age in patients with advanced IAB (median age 79 vs 68, p = 0.051). Moreover, they were more frequently treated with anticoagulants (42% vs 13%, p = 0.01), and they exhibited greater LA structural and functional remodelling documented by larger area (28 vs 26 cm2, p = 0.04) and greater minimum LA volume index—LAVi (43 ± 16 vs 36 ± 10, p = 0.04). Advanced IAB resulted to be an independent determinant of LA area (Beta 3.49 (0.37–6.60), p = 0.03) and minimum LAVi (Beta 7.22 (0.15–14.30), p = 0.045), and vice versa. LA electrical and structural remodelling is highly prevalent in a non-selected cohort of patients with acute HF. Advanced IAB on surface ECG is present in a high percentage of cases. Patients with advanced IAB tend to be older, and they exhibit higher degrees of LA structural and functional remodelling.
Similar content being viewed by others
References
Sanna GD, Moccia E, Beccu E, De Toni C, De Filippo V, Masia SL, Parodi G (2020) Left atrial remodelling in patients with heart failure: relationship between sphericity index and functional capacity and NT-proBNP levels (the SPHERICAT-HF study). Eur J Heart Fail 22(S1):2–415
Hoit BD (2014) Left atrial size and function: role in prognosis. J Am Coll Cardiol 63(6):493–505
Bisbal F, Baranchuk A, Braunwald E, Bayés de Luna A, Bayés-Genís A (2020) Atrial Failure as a Clinical Entity: JACC Review Topic of the Week. J Am Coll Cardiol 75(2):222–232
Rossi A, Temporelli PL, Quintana M, Dini FL, Ghio S, Hillis GS, Klein AL, Marsan NA, Prior DL, Yu CM, Poppe KK, Doughty RN, Whalley GA, Collaborators MHF (2009) Independent relationship of left atrial size and mortality in patients with heart failure: an individual patient meta-analysis of longitudinal data (MeRGE Heart Failure). Eur J Heart Fail 11(10):929–936
Patel RB, Shah SJ (2020) Therapeutic targeting of left atrial myopathy in atrial fibrillation and heart failure with preserved ejection fraction. JAMA Cardiol 5(5):497–499
Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L, Merkely B, Pokushalov E, Sanders P, Proff J, Schunkert H, Christ H, Vogt J, Bänsch D, Investigators CASTLE-AF (2018) Catheter Ablation for Atrial Fibrillation with Heart Failure. N Engl J Med 378(5):417–427
Bayes de Luna AJ (1979) Block at the auricular level. Rev Esp Cardiol 32(1):5–10
Sanna GD, Nusdeo G, Marini A, Ganga ML, Mura E, Pisano M, Sabino G, Parodi G (2021) Outcomes of single-lead VDD pacemakers in atrioventricular blocks: The OSCAR study. Int J Cardiol 325:62–68
Lacalzada-Almeida J, Izquierdo-Gómez MM, Belleyo-Belkasem C, Barrio-Martínez P, García-Niebla J, Elosua R, Jiménez-Sosa A, Escobar-Robledo LA, Bayés de Luna A (2018) Interatrial block and atrial remodeling assessed using speckle tracking echocardiography. BMC Cardiovasc Disord 18(1):38
Goyal SB, Spodick DH (2001) Electromechanical dysfunction of the left atrium associated with interatrial block. Am Heart J 142(5):823–827
Ciuffo L, Bruña V, Martínez-Sellés M, de Vasconcellos HD, Tao S, Zghaib T, Nazarian S, Spragg DD, Marine J, Berger RD, Lima JAC, Calkins H, Bayés-de-Luna A, Ashikaga H (2020) Association between interatrial block, left atrial fibrosis, and mechanical dyssynchrony: Electrocardiography-magnetic resonance imaging correlation. J Cardiovasc Electrophysiol 31(7):1719–1725
Dogdus M, Koyuncu I (2020) Comparison of clinical features and conventional echocardiographic characteristics of patients with heart failure with mid-range ejection fraction with and without interatrial block. Turk Kardiyol Dern Ars. https://doi.org/10.5543/tkda.2020.92345
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, ESC Scientific Document Group (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37(27):2129–2200
Martínez-Sellés M, Baranchuk A, Elosua R, de Luna AB (2017) Rationale and design of the BAYES (Interatrial Block and Yearly Events) registry. Clin Cardiol 40(4):196–199
Galderisi M, Cosyns B, Edvardsen T, Cardim N, Delgado V, Di Salvo G, Donal E, Sade LE, Ernande L, Garbi M, Grapsa J, Hagendorff A, Kamp O, Magne J, Santoro C, Stefanidis A, Lancellotti P, Popescu B, Habib G, 2016–2018 EACVI Scientific Documents Committee, 2016–2018 EACVI Scientific Documents Committee (2017) Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 18(12):1301–1310
Mitchell C, Rahko PS, Blauwet LA, Canaday B, Finstuen JA, Foster MC, Horton K, Ogunyankin KO, Palma RA, Velazquez EJ (2019) Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American society of echocardiography. J Am Soc Echocardiogr 32(1):1–64
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16(3):233–270
Badano LP, Miglioranza MH, Mihăilă S, Peluso D, Xhaxho J, Marra MP, Cucchini U, Soriani N, Iliceto S, Muraru D (2016) Left Atrial Volumes and Function by Three-Dimensional Echocardiography: Reference Values, Accuracy, Reproducibility, and Comparison With Two-Dimensional Echocardiographic Measurements. Circ Cardiovasc Imaging 9(7):e004229
Osmanagic A, Moller S, Osmanagic A, Sheta HM, Vinther KH, Egstrup K (2016) Left atrial sphericity index predicts early recurrence of atrial fibrillation after direct-current cardioversion: An Echocardiographic Study. Clin Cardiol 39(7):406–412
Escobar-Robledo LA, Bayés-de-Luna A, Lupón J, Baranchuk A, Moliner P, Martínez-Sellés M, Zamora E, de Antonio M, Domingo M, Cediel G, Núñez J, Santiago-Vacas E, Bayés-Genís A (2018) Advanced interatrial block predicts new-onset atrial fibrillation and ischemic stroke in patients with heart failure: The “Bayes’ Syndrome-HF” study. Int J Cardiol 271:174–180
Sadiq Ali F, Enriquez A, Conde D, Redfearn D, Michael K, Simpson C, Abdollah H, Bayés de Luna A, Hopman W, Baranchuk A (2015) Advanced interatrial block predicts new onset atrial fibrillation in patients with severe heart failure and cardiac resynchronization therapy. Ann Noninvasive Electrocardiol 20:586–591
Strait JB, Lakatta EG (2012) Aging-associated cardiovascular changes and their relationship to heart failure. Heart Fail Clin 8(1):143–164
Saremi F, Channual S, Krishnan S, Gurudevan SV, Narula J, Abolhoda A (2008) Bachmann Bundle and its arterial supply: imaging with multidetector CT–implications for interatrial conduction abnormalities and arrhythmias. Radiology 248(2):447–457
Bayés de Luna A, Martínez-Sellés M, Bayés-Genís A, Elosua R, Baranchuk A (2017) Surface ECG interatrial block-guided treatment for stroke prevention: rationale for an attractive hypothesis. BMC Cardiovasc Disord 17(1):211
Bayés de Luna A, Baranchuk A, Martínez-Sellés M, Platonov PG (2017) Anticoagulation in patients at high risk of stroke without documented atrial fibrillation. Time for a paradigm shift? Ann Noninvasive Electrocardiol 22(1):e12417
Martínez-Sellés M, Massó-van Roessel A, Álvarez-García J, García de la Villa B, Cruz-Jentoft AJ, Vidán MT, López Díaz J, Felix Redondo FJ, Durán Guerrero JM, Bayes-Genis A, Bayes de Luna A, Investigators of the Cardiac and Clinical Characterization of Centenarians (4C) registry (2016) Interatrial block and atrial arrhythmias in centenarians: Prevalence, associations, and clinical implications. Heart Rhythm 13(3):645–651
Martínez-Sellés M, Martínez-Larrú ME, Ibarrola M, Santos A, Díez-Villanueva P, Bayés-Genis A, Baranchuk A, Bayés-de-Luna A, Elosua R (2020) Interatrial block and cognitive impairment in the BAYES prospective registry. Int J Cardiol 321:95–98
Acknowledgements
The authors would like to thank Dr Eleonora Moccia, Dr Chiara De Toni and Dr Silvia Sanna for their help with clinical data collection.
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that there is no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
All the authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Sanna, G.D., Argiolas, D., Franca, P. et al. Relationship between electrocardiographic interatrial blocks and echocardiographic indices of left atrial function in acute heart failure. Heart Vessels 37, 50–60 (2022). https://doi.org/10.1007/s00380-021-01886-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00380-021-01886-z