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Predictive value of interatrial block on electrocardiogram among obese patients undergoing atrial fibrillation ablation

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Abstract

Background

Determine a predictive value of interatrial block (IAB) on atrial fibrillation (AF) ablation outcomes in obese patients.

Methods

Medical records were retrospectively reviewed for 205 consecutive patients with body mass indices (BMI) ≥ 30 kg/m2 who underwent initial AF ablation. Evidence of partial IAB defined as P-wave duration (PWD) ≥ 120 ms and advanced IAB with PWD ≥ 120 ms and biphasic or negative P-wave in inferior leads was examined from sinus electrocardiograms (ECGs) within 1-year pre-ablation. The primary outcome was recurrent atrial arrhythmia after 3-month blanking period post-ablation.

Results

The mean BMI was 36.9 ± 5.7 kg/m2. Partial IAB and advanced IAB were observed in 155 (75.61%) and 42 (20.49%) patients, respectively. During the median follow-up of 1.35 (interquartile range 0.74, 2.74) years, 115 (56.1%) patients had recurrent atrial arrhythmias. In multivariable analysis adjusting for age, gender, persistent AF, use of antiarrhythmic drugs (AADs), left atrial volume index (LAVI), partial IAB, and advanced IAB were independent predictors of recurrent arrhythmia with hazard ratio (HR) of 2.80 (95% confidence interval [CI] 1.47–6.05; p = 0.001) and HR 1.79 (95% CI 1.11–2.82; p = 0.017), respectively. The results were similar in a subgroup analysis of patients who had no severe left atrial enlargement and a subgroup analysis of patients who were not on AADs.

Conclusions

IAB is highly prevalent in patients with obesity and AF. Partial IAB, defined as PWD ≥ 120 ms, and advanced IAB with evidence of biphasic P-wave in inferior leads were independently associated with increased risk of recurrent arrhythmia after AF ablation. Its predictive value is independent of other traditional risk factors, LAVI, or use of AADs.

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Abbreviations

AAD:

Antiarrhythmic drugs

AF:

Atrial fibrillation

AHR:

Adjusted hazard ratio

BMI:

Body mass index

CI:

Confidence interval

ECG:

Electrocardiogram

IAB:

Interatrial block

IQR:

Interquartile range

LAVI:

Left atrial volume index

ms:

Millisecond

PW:

P-wave[Inline Image Removed]

PWD:

P-wave duration

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Acknowledgements

We kindly thank Priscilla Adjei with GE Healthcare technical support for providing invaluable technical guidance that facilitated data collection; James Aguto, Ryan Ruskamp, and Karen Blessing for assisting with data collection.

Funding

Financial support for this work was provided by the Jensen Research Funds, UNMC Division of Cardiology, Cardiac Electrophysiology. There were no relationships with industry.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239-3098, USA

    Hannah K Tandon

  2. Division of Cardiovascular Medicine, University of Nebraska Medical Center, 9882265 Nebraska Medical Center, Omaha, NE, 68198-2265, USA

    Kara Stout, David T Shin, Muaaz Almerstani, Ahmad Aroudaky, Jason P Payne, Neha Goyal, Shane F Tsai, Arthur Easley, Faris Khan, John R Windle, Daniel R Anderson, John William Schleifer & Niyada Naksuk

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  1. Hannah K Tandon
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Hannah Tandon, Kara Stout, David Shin, and Niyada Naksuk. The first draft of the manuscript was written by Hannah Tandon and Kara Stout. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Niyada Naksuk.

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Ethical approval

Ethical approval was waived by the local Ethics Committee of the University of Nebraska in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

Informed consent

Consent was waived by the local Ethics Committee of the University of Nebraska.

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The authors declare no competing interests.

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Tandon, H.K., Stout, K., Shin, D.T. et al. Predictive value of interatrial block on electrocardiogram among obese patients undergoing atrial fibrillation ablation. J Interv Card Electrophysiol 66, 1391–1399 (2023). https://doi.org/10.1007/s10840-022-01439-y

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  • DOI: https://doi.org/10.1007/s10840-022-01439-y

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