Advanced interatrial block: An electrocardiographic marker for stroke recurrence

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. •Advanced IAB is a marker for stroke recurrence in patients without AF.•This association is independent to the presence of atrial tachyarrhythmias and could be in relation with atrial cardiomyopathy.•These risk markers are important since the risk of stroke recurrence is increased in these patients.•A close follow-up of these patients and possible therapeutic interventions could help for the prevention of a new recurrence.