Electrocardiographic Advanced Interatrial Block and Atrial Fibrillation Risk in the General Population

      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bayes de Luna A.
        • Platonov P.
        • Cosio F.G.
        • Cygankiewicz I.
        • Pastore C.
        • Baranowski R.
        • Bayes-Genis A.
        • Guindo J.
        • Vinolas X.
        • Garcia-Niebla J.
        • Barbosa R.
        • Stern S.
        • Spodick D.
        Interatrial blocks. A separate entity from left atrial enlargement: a consensus report.
        J Electrocardiol. 2012; 45: 445-451
        • Bayes de Luna A.
        • Cladellas M.
        • Oter R.
        • Torner P.
        • Guindo J.
        • Marti V.
        • Rivera I.
        • Iturralde P.
        Interatrial conduction block and retrograde activation of the left atrium and paroxysmal supraventricular tachyarrhythmia.
        Eur Heart J. 1988; 9: 1112-1118
        • Bayes de Luna A.
        • Guindo J.
        • Vinolas X.
        • Martinez-Rubio A.
        • Oter R.
        • Bayes-Genis A.
        Third-degree inter-atrial block and supraventricular tachyarrhythmias.
        Europace. 1999; 1: 43-46
        • Enriquez A.
        • Sarrias A.
        • Villuendas R.
        • Ali F.S.
        • Conde D.
        • Hopman W.M.
        • Redfearn D.P.
        • Michael K.
        • Simpson C.
        • De Luna A.B.
        • Bayes-Genis A.
        • Baranchuk A.
        New-onset atrial fibrillation after cavotricuspid isthmus ablation: identification of advanced interatrial block is key.
        Europace. 2015; 17: 1289-1293
        • Sadiq Ali F.
        • Enriquez A.
        • Conde D.
        • Redfearn D.
        • Michael K.
        • Simpson C.
        • Abdollah H.
        • Bayes de Luna A.
        • Hopman W.
        • Baranchuk A.
        Advanced interatrial block predicts new onset atrial fibrillation in patients with severe heart failure and cardiac resynchronization therapy.
        Ann Noninvasive Electrocardiol. 2015; 20: 586-591
        • Enriquez A.
        • Conde D.
        • Hopman W.
        • Mondragon I.
        • Chiale P.A.
        • de Luna A.B.
        • Baranchuk A.
        Advanced interatrial block is associated with recurrence of atrial fibrillation post pharmacological cardioversion.
        Cardiovasc Ther. 2014; 32: 52-56
        • Alonso A.
        • Agarwal S.K.
        • Soliman E.Z.
        • Ambrose M.
        • Chamberlain A.M.
        • Prineas R.J.
        • Folsom A.R.
        Incidence of atrial fibrillation in whites and African-Americans: the Atherosclerosis Risk in Communities (ARIC) study.
        Am Heart J. 2009; 158: 111-117
        • Soliman E.Z.
        • Prineas R.J.
        • Case L.D.
        • Zhang Z.M.
        • Goff Jr., D.C.
        Ethnic distribution of ECG predictors of atrial fibrillation and its impact on understanding the ethnic distribution of ischemic stroke in the Atherosclerosis Risk in Communities (ARIC) study.
        Stroke. 2009; 40: 1204-1211
        • Epstein A.E.
        • Alexander J.C.
        • Gutterman D.D.
        • Maisel W.
        • Wharton J.M.
        Anticoagulation: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery.
        Chest. 2005; 128: 24S-27S
        • Loehr L.R.
        • Rosamond W.D.
        • Chang P.P.
        • Folsom A.R.
        • Chambless L.E.
        Heart failure incidence and survival (from the Atherosclerosis Risk in Communities study).
        Am J Cardiol. 2008; 101: 1016-1022
        • Zou G.
        A modified poisson regression approach to prospective studies with binary data.
        Am J Epidemiol. 2004; 159: 702-706
        • Benjamin E.J.
        • Levy D.
        • Vaziri S.M.
        • D'Agostino R.B.
        • Belanger A.J.
        • Wolf P.A.
        Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study.
        JAMA. 1994; 271: 840-844
        • Krahn A.D.
        • Manfreda J.
        • Tate R.B.
        • Mathewson F.A.
        • Cuddy T.E.
        The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study.
        Am J Med. 1995; 98: 476-484
        • Bayes de Luna A.
        • Fort de Ribot R.
        • Trilla E.
        • Julia J.
        • Garcia J.
        • Sadurni J.
        • Riba J.
        • Sagues F.
        Electrocardiographic and vectorcardiographic study of interatrial conduction disturbances with left atrial retrograde activation.
        J Electrocardiol. 1985; 18: 1-13
        • Daubert J.C.
        • Pavin D.
        • Jauvert G.
        • Mabo P.
        Intra- and interatrial conduction delay: implications for cardiac pacing.
        Pacing Clin Electrophysiol. 2004; 27: 507-525
        • Go A.S.
        • Hylek E.M.
        • Phillips K.A.
        • Chang Y.
        • Henault L.E.
        • Selby J.V.
        • Singer D.E.
        Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study.
        JAMA. 2001; 285: 2370-2375
        • Marcus G.M.
        • Olgin J.E.
        • Whooley M.
        • Vittinghoff E.
        • Stone K.L.
        • Mehra R.
        • Hulley S.B.
        • Schiller N.B.
        Racial differences in atrial fibrillation prevalence and left atrial size.
        Am J Med. 2010; 123: e371-e377

      Linked Article

      • Interatrial Block to Guide the Thromboembolic Prevention Strategy: Should It be the Next Step?
        American Journal of CardiologyVol. 120Issue 3
        • Preview
          We 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.
        • Full-Text
        • PDF