Kaplan Elmas, Ekizler Firdevs Aysenur, Saribas Halenur, Tufekcioglu Omac
Department of Cardiology, Cankırı State Hospital, Cankırı, Turkey.
Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey.
J Electrocardiol. 2025 Sep 1;93:154112. doi: 10.1016/j.jelectrocard.2025.154112.
Interatrial block (IAB) is an electrocardiographic manifestation of atrial conduction delay and structural remodeling. While it has been linked to atrial fibrillation (AF) and thromboembolic events, its potential role in predicting left atrial appendage (LAA) thrombus formation remains underexplored. This study aimed to investigate the association between IAB and the presence of LAA thrombus in patients with nonvalvular AF (NVAF) or atrial flutter referred for rhythm control procedures.
In this retrospective observational study, 750 patients with NVAF who underwent transesophageal echocardiography (TEE) prior to catheter ablation or cardioversion were evaluated. P-wave parameters were measured from digitally amplified 12‑lead ECGs, and IAB was defined according to current consensus criteria. Patients were stratified by the presence of LAA thrombus, and multivariate logistic regression was used to identify independent predictors.
LAA thrombus was detected in 10.8 % of patients. Those with thrombus were older and had higher thromboembolic risk scores, more frequent history of stroke, and lower left ventricular ejection fraction (LVEF). Interatrial block was observed in 85.2 % and advanced IAB in 44.4 % of patients with thrombus. In multivariate analysis, IAB (OR: 2.698; p = 0.008), larger LA diameter, lower LVEF, and greater P-wave dispersion were independently associated with thrombus presence.
IAB is independently associated with LAA thrombus in NVAF patients and may serve as a noninvasive marker to identify individuals at higher thromboembolic risk, potentially guiding the need for TEE before rhythm control.
房间阻滞（IAB）是心房传导延迟和结构重塑的一种心电图表现。虽然它与心房颤动（AF）和血栓栓塞事件有关，但其在预测左心耳（LAA）血栓形成方面的潜在作用仍未得到充分研究。本研究旨在探讨非瓣膜性房颤（NVAF）或心房扑动患者在接受节律控制程序时IAB与LAA血栓存在之间的关联。
在这项回顾性观察研究中，对750例在导管消融或复律前接受经食管超声心动图（TEE）检查的NVAF患者进行了评估。从数字放大的12导联心电图测量P波参数，并根据当前共识标准定义IAB。根据LAA血栓的存在对患者进行分层，并使用多因素逻辑回归来确定独立预测因素。
10.8%的患者检测到LAA血栓。有血栓的患者年龄更大，血栓栓塞风险评分更高，中风病史更频繁，左心室射血分数（LVEF）更低。在有血栓的患者中，85.2%观察到房间阻滞，44.4%观察到严重IAB。在多因素分析中，IAB（比值比：2.698；p = 0.008）、更大的左心房直径、更低的LVEF和更大的P波离散度与血栓存在独立相关。
IAB与NVAF患者的LAA血栓独立相关，可作为识别血栓栓塞风险较高个体的非侵入性标志物，可能指导节律控制前TEE的必要性。
