Highlights
- •The association between advanced interatrial block (IAB) and atrial fibrillation (AF) is known as “Bayes' Syndrome”.
- •In heart failure, 20.5% of patients had partial IAB, and 23.5% advanced IAB.
- •Advanced IAB was associated with new-onset AF, ischemic stroke, and the composite of both.
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.
Keywords
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Article info
Publication history
Published online: May 18, 2018
Accepted:
May 15,
2018
Received in revised form:
May 4,
2018
Received:
February 12,
2018
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Bayes syndrome: Improving risk stratification in chronic heart failure?International Journal of CardiologyVol. 271
- PreviewThe progressive ageing of population is leading to a significant increase of the incidence of heart failure (HF), one of the epidemics of the 21th Century. In addition, atrial fibrillation (AF) is the most common arrhythmia in elderly patients, and is associated with a higher incidence of stroke and mortality. A significant association between HF and AF has been consistently described, and its combination increases morbidity and mortality.
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