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      Potential Clinical Correlates and Risk Factors for Interatrial Block

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          Abstract

          Background: Interatrial block (IAB; P wave ≧110 ms) denotes a conduction delay between the atria, is strongly associated with atrial tachyarrhythmias, left atrial enlargement, left atrial electromechanical dysfunction, and is a risk for embolism. Despite this, potential risk factors for IAB have not been clearly defined. Methods: Patients admitted via the Emergency Department for nonacute medical reasons to the nontelemetry general medical floors of a tertiary care general hospital from October to November 2004 were screened for sinus rhythm on electrocardiograms. Four hundred and four patients who met our criteria were then evaluated for IAB on respective electrocardiograms. All patients were subsequently compared for common diseases as well as coronary artery disease (CAD) risk factors and divided into two groups, those with IAB and those without (control). Mean age ± standard deviation, odds ratios (ORs), 95% confidence intervals (CIs), r values, and p values were calculated. p values <0.05 were considered statistically significant. Results: From the sample (n = 404), 182 patients had IAB (45%; mean age 64.32 ± 19.27 years; males 51.6%) while 222 did not (control). CAD (OR 3.150, 95% CI 2.05–4.83; p < 0.001, r = 0.3), hypertension (OR 2.918, 95% CI 1.85–4.60; p < 0.001, r = 0.2), diabetes mellitus (OR 2.542, 95% CI 1.62–3.97; p < 0.001, r = 0.1), and hypercholesterolemia (OR 1.823, 95% CI 1.22–2.74; p = 0.004, r = 0.2) were significant risk factors and correlates for IAB. Multivariate analysis using stepwise linear regression revealed these factors as direct correlates of IAB. Conclusion: CAD, hypertension, diabetes mellitus and hypercholesterolemia appear to be risk factors for IAB in general hospital patients admitted for nonacute reasons. Considering the known sequelae of IAB, awareness of its associations with such risk factors could be important for patient risk stratification.

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          Most cited references 20

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          Electromechanical dysfunction of the left atrium associated with interatrial block.

          Our purpose was to determine the effect of interatrial block (IAB, P-wave duration >/=120 ms) on left atrial (LA) dynamics. IAB is associated with LA enlargement (LAE). LA dysfunction is associated with decreased left ventricular filling, a propensity for LA appendage thrombus formation, and reduced atrial natriuretic peptide levels. We evaluated LA function in patients with and without IAB matched for LA size. Echocardiograms with LA enlargement were analyzed. Twenty-four patients had IAB, and 16 patients without IAB formed the control group. LA volumes, A-wave acceleration times (At), LA stroke volume (LASV), ejection fraction (LAEF), and kinetic energy (LAKE) were calculated. The control group and patients with IAB had comparable maximal LA volume and diameter (P >.05). Patients with IAB had significantly longer At (115 +/- 39 ms vs 83 +/- 24 ms, P <.01) and smaller LASV (7 +/- 5 mL vs 17 +/- 6 mL, P <.01), LAEF (9% +/- 6% vs 25% +/- 8%, P <.01), and LAKE (20 +/- 14 vs 65 +/- 44 Kdyne/cm/s, P <.01). LAKE varied inversely with P-wave duration (r = -0.51, P <.01). P-wave duration and minimal LA volume were independent determinants of LAEF. Patients with IAB have a sluggish, poorly contractile LA, and the extent of dysfunction is related to the degree of electrical delay from IAB. IAB should be considered a marker of an electromechanically dysfunctional LA and hence a risk factor for atrial fibrillation and congestive heart failure.
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            Association of interatrial block with development of atrial fibrillation.

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              Clinical prediction rule for atrial fibrillation after coronary artery bypass grafting.

              This study was designed to devise and validate a practical prediction rule for atrial fibrillation/atrial flutter (AF) after coronary artery bypass grafting (CABG) using easily available clinical and standard electrocardiographic (ECG) criteria. Reported prediction rules for postoperative AF have suffered from inconsistent results and controversy surrounding the added predictive value of a prolonged P-wave duration. In 1,851 consecutive patients undergoing CABG with cardiopulmonary bypass, preoperative clinical characteristics and standard 12-lead ECG data were examined. Patients were continuously monitored for the occurrence of sustained postoperative AF while hospitalized. Multiple logistic regression was used to determine significant predictors of AF and to develop a prediction rule that was evaluated through jackknifing. Atrial fibrillation occurred in 508 of 1,553 patients (33%). Multivariate analysis showed that greater age (odds ratio [OR] 1.1 per year [95% confidence intervals (CI) 1.0 to 1.1], p 110 ms (OR 1.3 [95% CI 1.1 to 1.7], p = 0.02), and postoperative low cardiac output (OR 3.0 [95% CI 1.7 to 5.2], p = 0.0001) were independently associated with AF risk. Using the prediction rule we defined three risk categories for AF: or=80 points, 117 of 199 (59%). The area under the receiver-operator characteristic curve for the model was 0.69. These data show that post-CABG AF can be predicted with moderate accuracy using easily available patient characteristics and may prove useful in prognostic and risk stratification of patients after CABG. The presence of intraatrial conduction delay on ECG contributed least to the prediction model.
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                Author and article information

                Journal
                CRD
                Cardiology
                10.1159/issn.0008-6312
                Cardiology
                S. Karger AG
                0008-6312
                1421-9751
                2006
                May 2006
                11 May 2006
                : 105
                : 4
                : 213-218
                Affiliations
                aMassachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, bDepartment of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass., cDivision of Cardiology, and dDepartment of Medicine, Saint Vincent Hospital, eDepartment of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Mass., USA
                Article
                91642 Cardiology 2006;105:213–218
                10.1159/000091642
                16498245
                © 2006 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 1, Tables: 2, References: 25, Pages: 6
                Categories
                Original Research

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