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We read with great interest the article entitled “Predictive value of interatrial block on electrocardiogram among obese patients undergoing atrial fibrillation ablation” published in the Journal of Interventional Cardiac Electrophysiology by Tandon et al. [1]. They retrospectively analyzed 205 patients with body mass indices (BMI) ≥ 30 kg/m2 who underwent initial atrial fibrillation (AF) ablation. They concluded that partial interatrial block (IAB), defined as P-wave duration (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 in patients with obesity.
Similarly, a recent study by Wang et al. [2] also found that partial and advanced IAB were associated with AF recurrence in elderly patients with hypertension. Moreover, they further demonstrated that being overweight (BMI > 25 kg/m2) is a significant predictor of advanced IAB. The above two studies revealed that IAB was associated with AF recurrence after ablation and related to obesity.
A previous study has shown that IAB is correlated with the left atrial area [3]. Another study by Ciuffo et al. found that advanced IAB is associated with larger LA volumes, lower emptying fraction, and more fibrosis [4]. The above studies showed that the mechanisms underlying the IAB predicting recurrence of AF after ablation may partly be attributed to atrial fibrosis and atrial remodeling, which are considered anatomical substrates of advanced IAB. Obesity increases the risk of recurrence of AF after ablation [1, 2]. This provides us with a strategy to reduce the risk of recurrence of AF after ablation. Weight loss and avoidance of weight fluctuation constitute important strategies for reducing the rising burden of AF [5].
In conclusion, IAB can be used to predict the recurrence of AF after ablation among obese patients and weight control is an important prevention strategy. More clinical and basic research is needed to clarify the mechanisms between IAB and the recurrence of AF.
References
Tandon HK, Stout K, Shin DT, et al. Predictive value of interatrial block on electrocardiogram among obese patients undergoing atrial fibrillation ablation. J Interv Card Electrophysiol. 2022. https://doi.org/10.1007/s10840-022-01439-y.
Wang H, Cai L, Guo Y, Shuai L, Shi Y, Si Q. Advanced interatrial block predicts recurrence of atrial fibrillation and ischemic stroke in elderly patients with hypertension. Front Physiol. 2022;13:913454.
Ariyarajah V, Mercado K, Apiyasawat S, Puri P, Spodick DH. Correlation of left atrial size with p-wave duration in interatrial block. Chest. 2005;128(4):2615–8.
Ciuffo L, Bruña V, Martínez-Sellés M, et al. Association between interatrial block, left atrial fibrosis, and mechanical dyssynchrony: electrocardiography-magnetic resonance imaging correlation. J Cardiovasc Electrophysiol. 2020;31(7):1719–25.
Pathak RK, Middeldorp ME, Meredith M, et al. Long-term effect of goal-directed weight management in an atrial fibrillation cohort: a long-term follow-up study (Legacy). J Am Coll Cardiol. 2015;65(20):2159–69.
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Fan, QX., Mo, DG. Interatrial block can be used to predict the recurrence of atrial fibrillation after ablation among obese patients. J Interv Card Electrophysiol 66, 1307 (2023). https://doi.org/10.1007/s10840-023-01479-y
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DOI: https://doi.org/10.1007/s10840-023-01479-y