Usefulness of a Combination of Interatrial Block and a High CHADS₂ Score to Predict New Onset Atrial Fibrillation

Abstract

Interatrial block (IAB) is associated with an increased risk of atrial fibrillation (AF). The aim of this retrospective study was to investigate the association of a combination of IAB and the CHADS₂ score, an AF-related risk score for ischemic stroke, with new onset AF in patients in sinus rhythm. A total of 1,571 patients (803 males, 768 females; mean age: 58 ± 16 years) were included in this study. IAB was defined as a P-wave duration > 120 ms in the 12-lead electrocardiogram, and a high CHADS₂ score as ≥ 2 points. During the mean follow-up period of 4.8 ± 0.7 years, new onset AF occurred in 122 patients (16.1 per 1,000 patient-years). The incidence of new onset AF was 4.0 per 1,000 patient-years in patients with no IAB and a low CHADS₂ score, and 44.0 per 1,000 patient-years in patients with IAB and a high CHADS₂ score. In multivariate Cox regression analysis, the hazard ratio for IAB and a high CHADS₂ score compared with no IAB and a low CHADS₂ score was 12.18 (95% confidence interval: 6.22–23.87, P < 0.001), after adjustment for age, sex, coronary artery disease, valvular heart disease, smoking, medications, and echocardiographic parameters. In conclusion, IAB and a high CHADS₂ score independently and synergistically predict new onset AF in patients in sinus rhythm, indicating an approximately 12-fold higher risk in patients with both IAB and a high CHADS₂ score. Patients meeting these criteria should have more aggressive early intervention to prevent AF.