Although advanced interatrial block (aIAB) is an established electrocardiographic
phenotype, its prevalence, incidence, and prognostic significance in the general population
are unclear. We examined the prevalence, incidence, and prognostic significance of
aIAB in 14,625 (mean age = 54 ± 5.8 years; 26% black; 55% female) participants from
the Atherosclerosis Risk in Communities (ARIC) study. aIAB was detected from digital
electrocardiograms recorded during 4 study visits (1987 to 1989, 1990 to 1992, 1993
to 1995, and 1996 to 1998). Risk factors for the development of aIAB were examined
using multivariable Poisson regression models with robust variance estimates. Cox
regression was used to compute hazard ratios and 95% CIs for the association between
aIAB, as a time-dependent variable, and atrial fibrillation (AF). AF was ascertained
from study electrocardiogram data, hospital discharge records, and death certificates
thorough 2010. A total of 69 participants (0.5%) had aIAB at baseline, and 193 (1.3%)
developed aIAB during follow-up. The incidence for aIAB was 2.27 (95% CI 1.97 to 2.61)
per 1,000 person-years. Risk factors for aIAB development included age, male gender,
white race, antihypertensive medication use, low-density lipoprotein cholesterol,
body mass index, and systolic blood pressure. In a Cox regression analysis adjusted
for sociodemographics, cardiovascular risk factors, and potential confounders, aIAB
was associated with an increased risk for AF (hazard ratio 3.09, 95% CI 2.51 to 3.79).
In conclusion, aIAB is not uncommon in the general population. Risk factors for developing
aIAB are similar to those for AF, and the presence of aIAB is associated with an increased
risk for AF.
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Article info
Publication history
Published online: March 17, 2016
Accepted:
March 1,
2016
Received in revised form:
March 1,
2016
Received:
December 29,
2015
Footnotes
The Atherosclerosis Risk in Communities study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute, Bethesda, Maryland contracts (HHSN268201100005 C, HHSN268201100006 C, HHSN268201100007 C, HHSN268201100008 C, HHSN268201100009 C, HHSN268201100010 C, HHSN268201100011 C, and HHSN268201100012 C).
See page 1758 for disclosure information.
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© 2016 Elsevier Inc. All rights reserved.
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- Interatrial Block to Guide the Thromboembolic Prevention Strategy: Should It be the Next Step?American Journal of CardiologyVol. 120Issue 3
- PreviewWe read with great interest the study by O'Neal et al recently published in the American Journal of Cardiology.1 This is the largest epidemiological prospective observational study which explored the arrhythmogenic potential of advanced interatrial block (aIAB). The investigators demonstrated that aIAB was associated with a significantly increased risk for atrial fibrillation (AF) after adjustment for sociodemographics and other cardiovascular risk factors. An additional potential area of exploration in this large patient cohort would be to determine the thromboembolic association of aIAB.
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