García-Talavera Camila S, Aceña Álvaro, Andrés López Alberto, García Torres María Araceli, Olivié García Laura, de la Cruz Berlanga Elena, de Los Reyes Oliva Encabo María, Franco-Peláez Juan, Tuñón José, Rubio José Manuel
Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain; Autónoma University, Madrid, Spain.
J Electrocardiol. 2019 Nov-Dec;57:1-5. doi: 10.1016/j.jelectrocard.2019.07.005. Epub 2019 Jul 8.
The presence of interatrial block (IAB) has been directly related to the appearance of various atrial tachyarrhythmias and therefore could be a risk factor for stroke. The objective of this study is to establish whether the presence of IAB could predict stroke recurrence in patients with a previous episode.
We included all patients discharged from our hospital in 2011 following treatment for stroke, excluding those of cardioembolic or lacunar etiology. For all patients we analyzed the ECG recordings, determined whether the patient presented cardiovascular risk factors, and determined the presence and type of IAB. An IAB was defined as partial if the P-wave duration was ≥120 ms, and advanced if the duration was ≥120 ms and presented biphasic morphology in the inferior leads. The primary endpoint was the recurrence of stroke and the secondary endpoint was the incidence of atrial tachyarrhythmias after the first episode.
A total of 149 patients were identified (80 (71.5-86.0) years, 41% men). After a median follow-up of 3.96 (0.63-5.35) years, 54 deaths (36%) were observed, 27 patients (18%) had experienced stroke recurrence, and 20 (13%) had developed atrial tachyarrhythmias. On multivariate analysis, the presence of advanced IAB [HR: 2.3, 95% CI (1.0-5.5); p = 0.043] and diabetes [HR: 2.5, 95% CI (1.1-5.4); p = 0.018] were significantly associated with stroke recurrence.
The presence of advanced IAB predicts the recurrence of stroke in patients with a previous episode. Further studies should be performed to investigate possible interventions.
房间隔阻滞（IAB）的存在与各种房性快速心律失常的出现直接相关，因此可能是中风的危险因素。本研究的目的是确定IAB的存在是否能预测既往有中风发作的患者中风复发情况。
我们纳入了2011年在我院接受中风治疗后出院的所有患者，排除心源性栓塞或腔隙性病因的患者。对所有患者，我们分析了心电图记录，确定患者是否存在心血管危险因素，并确定IAB的存在情况及类型。如果P波时限≥120毫秒，则定义为不完全性IAB；如果时限≥120毫秒且在下壁导联呈现双相形态，则定义为完全性IAB。主要终点是中风复发，次要终点是首次发作后房性快速心律失常的发生率。
共纳入149例患者（年龄80（71.5 - 86.0）岁，男性占41%）。中位随访时间为3.96（0.63 - 5.35）年，观察到54例死亡（36%），27例患者（18%）发生中风复发，20例（13%）发生房性快速心律失常。多因素分析显示，完全性IAB的存在[风险比：2.3，95%置信区间（1.0 - 5.5）；p = 0.043]和糖尿病[风险比：2.5，95%置信区间（1.1 - 5.4）；p = 0.018]与中风复发显著相关。
完全性IAB的存在可预测既往有中风发作的患者中风复发。应进行进一步研究以探讨可能的干预措施。
