Prevalence of P wave dispersion and interatrial block in patients with systolic heart failure and their relationship with functional status, hospitalization and one year mortality

Background and objectives: P-wave dispersion (PWD) and Interatrial block (IAB) are common in heart failure (HF), and could be associated with adverse cardiac events. We aimed to assess the prevalence of PWD and IAB and their relationship with functional status, hospitalization and mortality rate in patients with systolic HF. Methods: We enrolled 110 HF patients in sinus rhythm & LVEF <50%. Patients had undergone clinical evaluation, 6 min walking test (6MWT), 12-lead electrocardiography (ECG), 24-h Holter ECG & echocardiogram. Hospitalization and mortality rate were followed-up for one year. PWD was defined as the difference between maximum & minimum P-wave duration >40 ms. IAB was defined as maximum P duration >110 ms. Measurements were done by 2 blinded investigators using a caliber, a ruler and a magnifying lens. Results: Mean age was 58.9 ± 9.7 years and 67.3% were males. Prevalence of PWD and IAB was 68.2% and 57.3%, respectively. Patients with PWD showed these features: 84% in NYHA class III or IV HF, 77.4% had LVEF <35%, 78.7% had paroxysmal Atrial Fibrillation (AF) and 89.4% couldn't complete >200 m (m) in 6MWT. Patients with PWD had more hospitalizations (72% vs 28.6%, P value <0.02) and higher 1-year mortality rate (20% vs 8.6%, P value <0.04) than patients without PWD. Likewise, patients with IAB had nearly similar clinical features, hospitalization and mortality as patients with PWD. Conclusion: PWD and IAB are prevalent in patients with systolic HF and they are significantly associated with low LVEF, paroxysmal AF, poor functional capacity, hospitalization and mortality rate.