Spyridon Deftereos1, Charalampos Kossyvakis2, Michael Efremidis3, Georgios Bouras4, Vasiliki Panagopoulou5, Charalampos Papadimitriou4, Konstantinos Doudoumis4, Gerasimos Deftereos4, Andreas Synetos6, Periklis Davlouros7, Konstantinos Toutouzas6, Dimitrios Alexopoulos7, Antonis S Manolis6, Georgios Giannopoulos8. 1. Department of Cardiology, Athens General Hospital "G. Gennimatas," Athens, Greece; Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut. 2. Department of Cardiology, Athens General Hospital "G. Gennimatas," Athens, Greece; Hellenic Center for Disease Control and Prevention, Athens, Greece. 3. 2nd Department of Cardiology, Evaggelismos General Hospital, Athens, Greece. 4. Department of Cardiology, Athens General Hospital "G. Gennimatas," Athens, Greece. 5. 1st Department of Cardiology, University of Athens Medical School, Athens, Greece; Hellenic Center for Disease Control and Prevention, Athens, Greece. 6. 1st Department of Cardiology, University of Athens Medical School, Athens, Greece. 7. Department of Cardiology, University of Patras Medical School, Patras, Greece. 8. Department of Cardiology, Athens General Hospital "G. Gennimatas," Athens, Greece; Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut; Hellenic Center for Disease Control and Prevention, Athens, Greece. Electronic address: ggiann@med.uoa.gr.
Abstract
BACKGROUND: Atrial electrical conduction properties have been implicated in atrial fibrillation (AF) pathogenesis. OBJECTIVE: The purpose of this study was to prospectively assess the potential association of interatrial conduction time (IACT) with incident AF. METHODS: The study included persons referred for invasive electrophysiologic study (EPS), aged ≥50 years, without AF history or valvular disease. IACT was defined as the interval between the high right atrium electrogram and the distal coronary sinus atrial electrogram. RESULTS: Six hundred twelve subjects were included (median follow-up 43 months, interquartile range 40-47). AF incidence was 21.7 cases per 1000 person-years. IACT was a significant predictor of AF with a c-statistic of 0.770 (95% confidence interval 0.702-0.838). In time-dependent analysis, IACT was a significant stratifier of AF risk (log-rank 28.0, P <.001). The corresponding incidences of AF in each tertile of IACT were 3, 17, and 46 per 1000 person-years, respectively (all differences between tertiles were significant). IACT remained significant in multivariable Cox regression analysis, after adjustment for age, sex, hypertension, and left atrial diameter, with each millisecond of prolonged IACT corresponding to 7% (95% confidence interval 2%-12%) higher adjusted risk of incident AF. CONCLUSION: IACT is independently associated with incident AF. The invasive nature of the measurement is a limitation for its use as a clinical risk stratifier (although it could be used in patients referred for EPS), but these results are of interest in themselves because they suggest a strong pathophysiologic connection between atrial conduction times and substrate alterations ultimately leading to AF.
BACKGROUND: Atrial electrical conduction properties have been implicated in atrial fibrillation (AF) pathogenesis. OBJECTIVE: The purpose of this study was to prospectively assess the potential association of interatrial conduction time (IACT) with incident AF. METHODS: The study included persons referred for invasive electrophysiologic study (EPS), aged ≥50 years, without AF history or valvular disease. IACT was defined as the interval between the high right atrium electrogram and the distal coronary sinus atrial electrogram. RESULTS: Six hundred twelve subjects were included (median follow-up 43 months, interquartile range 40-47). AF incidence was 21.7 cases per 1000 person-years. IACT was a significant predictor of AF with a c-statistic of 0.770 (95% confidence interval 0.702-0.838). In time-dependent analysis, IACT was a significant stratifier of AF risk (log-rank 28.0, P <.001). The corresponding incidences of AF in each tertile of IACT were 3, 17, and 46 per 1000 person-years, respectively (all differences between tertiles were significant). IACT remained significant in multivariable Cox regression analysis, after adjustment for age, sex, hypertension, and left atrial diameter, with each millisecond of prolonged IACT corresponding to 7% (95% confidence interval 2%-12%) higher adjusted risk of incident AF. CONCLUSION: IACT is independently associated with incident AF. The invasive nature of the measurement is a limitation for its use as a clinical risk stratifier (although it could be used in patients referred for EPS), but these results are of interest in themselves because they suggest a strong pathophysiologic connection between atrial conduction times and substrate alterations ultimately leading to AF.
Authors: David M German; Muammar M Kabir; Thomas A Dewland; Charles A Henrikson; Larisa G Tereshchenko Journal: Ann Noninvasive Electrocardiol Date: 2015-11-02 Impact factor: 1.468
Authors: Fabienne Kreimer; Assem Aweimer; Andreas Pflaumbaum; Andreas Mügge; Michael Gotzmann Journal: Ann Noninvasive Electrocardiol Date: 2021-05-07 Impact factor: 1.468