Luis Alberto Escobar-Robledo1, Antoni Bayés-de-Luna2, Josep Lupón1, Adrian Baranchuk3, Pedro Moliner1, Manuel Martínez-Sellés4, Elisabet Zamora1, Marta de Antonio1, Mar Domingo1, Germán Cediel1, Julio Núñez5, Evelyn Santiago-Vacas1, Antoni Bayés-Genís6. 1. Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain. 2. Autonomous University of Barcelona and Institut Català Ciències Cardiovasculars (ICCC)-St. Pau Hospital, Barcelona, Spain. 3. Division of Cardiology, Queen's University, Kingston, Ontario, Canada. 4. Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Complutense, Universidad Europea, Madrid. Spain. 5. Cardiology Department, Hospital Clínico Universitario, INCLIVA, CIBERCV, Departamento de Medicina, Universitat de València, Valencia, Spain. 6. Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain. Electronic address: abayesgenis@gmail.com.
Abstract
AIMS: 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.
AIMS: 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.
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