Baseline ECG and prognosis after transcatheter aortic valve implantation: the role of interatrial block

Background: The clinical significance of conduction disturbances after transcatheter aortic valve implantation has been described; however, little is known about the influence of baseline ECGs in the prognosis of these patients. Our aim was to study the influence of baseline ECG parameters, including interatrial block (IAB), in the prognosis of patients treated with transcatheter aortic valve implantation. Methods and Results: The BIT (Baseline Interatrial Block and Transcatheter Aortic Valve Implantation) registry included 2527 patients with aortic stenosis treated with transcatheter aortic valve implantation. A centralized analysis of baseline ECGs was performed. Patients were divided into 4 groups: normal P wave duration (<120 ms); partial IAB (P wave duration ≥120 ms, positive in the inferior leads); advanced IAB (P wave duration ≥120 ms, biphasic [+/-] morphology in the inferior leads); and nonsinus rhythm (atrial fibrillation/flutter and paced rhythm). The mean age of patients was 82.6±9.8 years and 1397 (55.3%) were women. A total of 960 patients (38.0%) had a normal P wave, 582 (23.0%) had partial IAB, 300 (11.9%) had advanced IAB, and 685 (27.1%) presented with nonsinus rhythm. Mean follow‐up duration was 465±171 days. Advanced IAB was the only independent predictor of all‐cause mortality (hazard ratio [HR], 1.48; 95% CI, 1.10-1.98 [P=0.010]) and of the composite end point (death/stroke/new atrial fibrillation) (HR, 1.51; 95% CI, 1.17-1.94 [P=0.001]). Conclusions: Baseline ECG characteristics influence the prognosis of patients with aortic stenosis treated with transcatheter aortic valve implantation. Advanced IAB is present in about an eighth of patients and is associated with all‐cause death and the composite end point of death, stroke, and new atrial fibrillation during follow‐up

Espacio y territorios: razón, pasión e imaginarios

En este caleidoscopio de acercamientos hacia lo espacial y territorial, las visiones se mueven desde aquellas románticas y existencialistas, pasando por aquellas objetivistas y positivistas, hasta las estructuralistas y postestructuralistas. Por el espacio y el territorio se interesan con enfoques diversos numerosas disciplinas, desde la psicología, la etología o la literatura, y las ciencias naturales como la biología o la ecología, hasta las ciencias sociales y políticas, como la geografía, la antropología, la economía y la sociología. Este interés multidisciplinario demuestra la importancia y la complejidad del tema espacial y territorial, y reclama la necesidad de su estudio y comprensión interdisciplinarios, como se intenta con esta publicación

Interatrial Block and the Risk of Ischemic Stroke

Sin financiación3.042 JCR (2017) Q2, 24/65 Peripheral Vascular DiseaseUE

Diagnosis of interatrial block

Sin financiación1.581 JCR (2017) Q3, 89/128 Cardiac and Cardiovascular Systems; Q4, 40/53 Geriatrics and GerontologyUE

ECG patterns of typical and atypical advanced interatrial block: prevalence and clinical relevance

Sin financiación4.753 JCR (2020) Q2, 45/142 Cardiac & Cardiovascular Systems0.455 SJR (2020) Q3, 202/349 Cardiology & Cardiovascular MedicineNo data IDR 2020UE

Prevalencia y relevancia clínica de los tipos de bloqueo interauricular avanzado típico y atípico

Sin financiaciónNo data JCR 20200.995 SJR (2020) Q1, 558/2448 Medicine (miscellaneous)No data IDR 2020UE

Rational and design of the Baseline Interatrial block and Transcatheter aortic valve implantation (BIT) registry

Background Aortic stenosis (AS) is currently the most frequent heart valve disease. Symptomatic severe AS has a poor prognosis and transcatheter aortic valve implantation (TAVI) is becoming the therapy of choice in these patients. Changes in the conduction tissue after the procedure constitute one of the main limitations of TAVI, with a frequent need for a definitive pacemaker. Interatrial block (IAB) is defined as a prolonged P-wave duration and is related with atrial fibrosis. The presence of IAB could be a marker of conduction tissue abnormalities at other levels. No study has specifically analyzed the role of IAB as a predictor of the need for permanent pacemaker in patients with AS undergoing TAVI. Methods The Baseline Interatrial block and Transcatheter aortic valve implantation (BIT) registry will be performed in approximately 3000 patients with severe AS treated with TAVI. A centralized analysis of baseline ECGs will study the presence and type of IAB and other ECG data (rhythm, P-wave duration, PR and QRS intervals/intraventricular conduction disorders). Clinical follow-up will be carried out by local researchers. The primary endpoint will be the requirement of permanent pacemaker during post-TAVI hospitalization. As secondary objectives, the incidence of new onset AF, stroke, or mortality during follow-up will be analyzed. Secondary endpoints will include the incidence of new onset AF, stroke, or mortality during follow-up. Conclusion The BIT registry will study, for the first time, the influence of previous IAB in the need of permanent pacemaker after TAVI: This large registry will also provide information regarding the association of this and other ECG parameters with prognosis.Sin financiación0.944 JCR (2019) Q4, 133/138 Cardiac & Cardiovascular Systems0.448 SJR (2019) Q3, 205/362 Cardiology and Cardiovascular MedicineNo data IDR 2019UE

Interatrial block, frailty and prognosis in elderly patients with myocardial infarction

Background: Interatrial block (IAB) is associated with atrial fibrillation (AF) in different clinical situations, but little information exists in elderly patients with myocardial infarction (MI) and its association with frailty. Methods: Consecutive MI patients aged ≥ 75 years were prospectively included. Frailty was assessed during the admission, as well as the prevalence of IAB. Main outcome measure was mortality and new onset AF at one year. Results: We included 254 patients. From 220 patients with sinus rythm (86.6%), 37 had partial IAB (16.8%) and 34 advanced IAB (15.5%). Patients with advanced IAB had lower values of handgrip strenght (19.8 vs 21.7 kg, p 0.073). These patients had a trend toward higher incidence of AF or mortality during follow up (HR 1.51, 95% CI 0.85–2.70, p = 0.164). Conclusions: Advanced IAB was associated with a trend toward higher prevalence of frailty. Elderly patients with MI and advanced IAB had a trend toward higher incidence of AF.Sin financiación1.166 JCR (2018) Q4, 119/136 Cardiac & Cardiovascular Systems0.547 SJR (2018) Q2, 176/365 Cardiology and Cardiovascular MedicineNo data IDR 2018UE

Atypical advanced interatrial blocks: Definition and electrocardiographic recognition

The diagnosis of advanced interatrial block (A-IAB) is done by surface ECG analysis when the P-wave ≥120 ms with biphasic (±) morphology in leads II, III and aVF. In this brief communication, we advance a new concept involving atypical patterns of A-IAB due to changes about the morphology or duration of the P-wave. It remains to be determined its real prevalence in different clinical scenarios, and whether these atypical ECG patterns should be considered as predictors of atrial fibrillation/stroke.Sin financiación1.166 JCR (2018) Q4, 119/136 Cardiac & Cardiovascular Systems0.547 SJR (2018) Q2, 176/365 Cardiology and Cardiovascular MedicineNo data IDR 2018UE

Advanced interatrial block predicts new-onset atrial fibrillation and ischemic stroke in patients with heart failure: The “Bayes' Syndrome-HF” study

Advanced interatrial block (IAB) is characterized by a prolonged (≥120 ms) and bimodal P wave in the inferior leads. The association between advanced IAB and atrial fibrillation (AF) is known as “Bayes' Syndrome”, and there is scarce information about it in heart failure (HF). We examined the prevalence of IAB and whether advanced IAB could predict new-onset AF and/or stroke in HF patients. Methods and results: The prospective observational “Bayes' Syndrome-HF” study included consecutive outpatients with chronic HF. The primary endpoints were new-onset AF, ischemic stroke, and the composite of both. A secondary endpoint included all-cause death alone or in combination with the primary endpoint. Comprehensive multivariable Cox regression analyses were performed. Among 1050 consecutive patients, 536 (51.0%) were in sinus rhythm, 464 with a measurable P wave are the focus of this study. Two-hundred and sixty patients (56.0%) had normal atrial conduction, 95 (20.5%) partial IAB, and 109 (23.5%) advanced IAB. During a mean follow-up of 4.5 ± 2.1 years, 235 patients experienced all-cause death, new-onset AF, or stroke. In multivariable comprehensive Cox regression analyses, advanced IAB was associated with new-onset AF (HR 2.71 [1.61–4.56], P < 0.001), ischemic stroke (HR 3.02 [1.07–8.53], P = 0.04), and the composite of both (HR 2.42 [1.41–4.15], P < 0.001). Conclusions: In patients with HF advanced IAB predicts new-onset AF and ischemic stroke. Future studies must assess whether anticoagulant treatment in Bayes' Syndrome leads to better outcomes in HF.Sin financiación3.471 JCR (2018) Q2, 48/136 Cardiac & Cardiovascular Systems0.990 SJR (2018) Q2, 91/365 Cardiology and Cardiovascular MedicineNo data IDR 2018UE