Interatrial blocks prevalence and risk factors for human immunodeficiency virus-infected persons

Autoři: Francisco Fanjul aff001;  Antoni Campins aff001;  Javier Asensio aff001;  Gloria Sampériz aff003;  Aina Yañez aff004;  Dora Romaguera aff002;  Miquel Fiol aff002;  Melchor Riera aff001
Působiště autorů: Infectious Diseases Unit, University Hospital Son Espases, Palma de Mallorca, Spain aff001;  Illes Balears Health Research Institute (IdISBa), Palma de Mallorca, Spain aff002;  Infectious Diseases Unit, University Hospital Miguel Servet, Zaragoza, Spain aff003;  Faculty of Nursing and Physiotherapy, Illes Balears University, Palma de Mallorca, Spain aff004;  Physiopathology of Obesity and Nutrition CIBER (CIBER-OBN), Palma de Mallorca, Spain aff005
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223777



Interatrial blocks are considered a new important risk factor for atrial fibrillation and cerebrovascular events. Their prevalence and clinical implications have been reported in general population and several subgroups of patients but no data from HIV-infected populations, with a non-negligible prevalence of atrial fibrillation, has been previously reported.


We conducted a cross-sectional study in a previously enrolled cohort of randomly selected middle-aged HIV-infected patients who attended our hospital and were clinically stable.

Patients underwent both a 12-lead rest electrocardiogram and clinical questionnaires while epidemiological, clinical and HIV-related variables were obtained from electronic medical records and interviews with the patients. Electrocardiograms were then analyzed and codified using a standardized form by two trained members of the research team who were blinded to clinical variables.


We obtained electrocardiograms from 204 patients with a mean age of 55.22 years, 39 patients (19.12%) presented an interatrial block, 9 (4.41%) advanced and 30 (14.71%) partial. Patients with interatrial block had a lower nadir lymphocyte CD4 count (124 vs 198 cells, p = 0.02) while advanced interatrial blocks were associated to older age (62.16 vs. 54.95 years, p = 0.046) and hypertension (77.8% vs. 32.3%, p = 0.009). We did not find differences regarding baseline CD4 lymphocyte count or CD4/CD8 lymphocyte ratio. Clinical variables and functional capacity among patients with or without interatrial block were similar.


In a cohort of clinically stable HIV infected patients the prevalence of interatrial blocks, specially advanced, is high and associated to previously known factors (age, hypertension) and novel ones (nadir CD4 lymphocyte count).

Klíčová slova:

Body mass index – Cardiovascular diseases – Electrocardiography – Hepatitis C virus – HIV infections – Hypertension – Chronic obstructive pulmonary disease – Medical risk factors


1. Njoku PO, Ejim EC, Anisiuba BC, Ike SO, Onwubere BJ. Electrocardiographic findings in a cross-sectional study of human immunodeficiency virus (HIV) patients in Enugu, south-east Nigeria. Cardiovasc J Afr. South Africa; 2016;27: 252–257. doi: 10.5830/CVJA-2016-007 27841913

2. Hamadou B, Ngweth MN, Fotso MM, Mfeukeu-Kuate L, Jingi AM, Noubiap JJ, et al. Echocardiographic and electrocardiographic abnormalities in adults living with human immunodeficiency virus: a cross-sectional study in the Yaoundé Central Hospital, Cameroon. Cardiovasc Diagn Ther. 2017;7: 607–615. doi: 10.21037/cdt.2017.10.12 29302466

3. Soliman E, Prineas R. Prevalence and Prognostic Significance of ECG Abnormalities in HIV-infected Patients: Results from the Strategies for Management of Antiretroviral Therapy (SMART) J Electrocardiol. 2011 Nov; 44(6): 779–785.

4. Hemkens LG, Bucher HC. HIV infection and cardiovascular disease. Eur Heart J. 2014;35: 1373–1381. doi: 10.1093/eurheartj/eht528 24408888

5. Ogunmola OJ, Oladosu YO, Olamoyegun MA. QTc interval prolongation in HIV-negative versus HIV-positive subjects with or without antiretroviral drugs. Ann Afr Med. India; 2015;14: 169–176. doi: 10.4103/1596-3519.152072 26470741

6. Hsu JC, Li Y, Marcus GM, Hsue PY, Scherzer R, Grunfeld C, et al. Atrial fibrillation and atrial flutter in human immunodeficiency virus-infected persons: incidence, risk factors, and association with markers of HIV disease severity. J Am Coll Cardiol. United States; 2013;61: 2288–2295. doi: 10.1016/j.jacc.2013.03.022 23563125

7. Sanders JM, Steverson AB, Pawlowski AE, Schneider D, Achenbach CJ, Lloyd-Jones DM, et al. Atrial arrhythmia prevalence and characteristics for human immunodeficiency virus-infected persons and matched uninfected controls. PLoS One. 2018; doi: 10.1371/journal.pone.0194754 29558525

8. Carr A, Grund B, Neuhaus J, El-Sadr WM, Grandits G, Gibert C, et al. Asymptomatic myocardial ischaemia in HIV-infected adults. AIDS. England; 2008;22: 257–267. doi: 10.1097/QAD.0b013e3282f20a77 18097228

9. Pastori D, Lip GYH, Mezzaroma I, Pignatelli P, Violi F. Atrial fibrillation and human immunodeficiency virus type-1 infection: a systematic review. Implications for anticoagulant and antiarrhythmic therapy. Br J Clin Pharmacol 2019; 85:508–515. doi: 10.1111/bcp.13837 30575989

10. Bayés De Luna A, Platonov P, Cosio FG, Cygankiewicz I, Pastore C, Baranowski R, et al. Interatrial blocks. A separate entity from left atrial enlargement: A consensus report. Journal of Electrocardiology. 2012. doi: 10.1016/j.jelectrocard.2012.06.029 22920783

11. Condea D, Baranchuk A. Bloqueo interauricular como sustrato anatómico-eléctrico de arritmias supraventriculares: Síndrome de bayés. Arch Cardiol Mex. 2014;84: 32–40.

12. Lacalzada-Almeida J, Izquierdo-Gómez MM, Belleyo-Belkasem C, Barrio-Martínez P, García-Niebla J, Elosua R, et al. Interatrial block and atrial remodeling assessed using speckle tracking echocardiography. BMC Cardiovasc Disord. BMC Cardiovascular Disorders; 2018;18: 1–9.

13. Baranchuk A, Enriquez A, Antiperovitch P, Alexander B, Cinier G. Advanced interatrial block as a key marker for atrial fibrillation recurrence: Bayés’ syndrome. J Geriatr Cardiol. 2017;14: 169–173. doi: 10.11909/j.issn.1671-5411.2017.03.005 28592959

14. O’Neal WT, Zhang ZM, Loehr LR, Chen LY, Alonso A, Soliman EZ. Electrocardiographic Advanced Interatrial Block and Atrial Fibrillation Risk in the General Population. Am J Cardiol. 2016; doi: 10.1016/j.amjcard.2016.03.013 27072646

15. Rubio Campal JM, Benezet-Mazuecos J, Iglesias Bravo JA, Sánchez Borque P, Miracle Blanco Á, de la Vieja Alarcón JJ, et al. P-wave and interatrial block: New predictor for atrial high rate episodes in patients with cardiac implantable electronic devices. PACE—Pacing Clin Electrophysiol. 2018;41: 223–228. doi: 10.1111/pace.13268 29327362

16. Ninios I, Pliakos C, Ninios V, Karvounis H, Louridas G. Prevalence of interatrial block in a general population of elderly people. Ann Noninvasive Electrocardiol. 2007;12: 298–300. doi: 10.1111/j.1542-474X.2007.00178.x 17970954

17. Baranchuk A, Parfrey B, Lim L, Morriello F, Simpson CS, Hopma WM, et al. Interatrial block in patients with obstructive sleep apnea. Cardiology. 2011;18: 171–5.

18. Enriquez A, Conde D, Femenia F, De Luna AB, Ribeiro A, Muratore C, et al. Relation of interatrial block to new-onset atrial fibrillation in patients with Chagas cardiomyopathy and implantable cardioverter-defibrillators. Am J Cardiol. Elsevier Inc.; 2014;113: 1740–1743. doi: 10.1016/j.amjcard.2014.02.036 24698463

19. Ertem AG, Yayla Ç, AçAr B, Ünal, Erdol MA, Sonmezer C, et al. Assessment of the atrial electromechanical properties of patients with human immunodeficiency virus. J Infect Public Health. 2017;10: 721–724. doi: 10.1016/j.jiph.2016.10.008 28162963

20. Sainz T, Serrano-Villar S, Díaz L, Tomé MIG, Gurbindo MD, de José MI, et al. The CD4/CD8 ratio as a marker T-cell activation, senescence and activation/exhaustion in treated HIV-infected children and young adults. AIDS. 2013;27: 1513–1516. doi: 10.1097/QAD.0b013e32835faa72 23435292

21. Sampériz G, Guerrero D, López M, Valera JL, Iglesias A, Ríos Á, et al. Prevalence of and risk factors for pulmonary abnormalities in HIV-infected patients treated with antiretroviral therapy. 2014; 321–329. doi: 10.1111/hiv.12117 24314004

22. Meguro M, Barley EA, Spencer S, Jones PW. Development and validation of an improved, COPD-specific version of the St. George respiratory questionnaire. Chest. The American College of Chest Physicians; 2007;132: 456–463. doi: 10.1378/chest.06-0702 17646240

23. ROSE GA. The diagnosis of ischaemic heart pain and intermittent claudication in field surveys. Bull World Health Organ. 1962;27: 645–658. 13974778

24. Martínez-Sellés M. Prevalence and incidence of interatrial block in global population and in different clinical situations. J Geriatr Cardiol. 2017;14: 158–160. doi: 10.11909/j.issn.1671-5411.2017.03.006 28592956

25. Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med. 2017;195: 557–582. doi: 10.1164/rccm.201701-0218PP 28128970

26. Abdellah AT, El-Nagary M. 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. Egypt Hear J. Egyptian Society of Cardiology; 2018;70: 181–187. doi: 10.1016/j.ehj.2018.02.006 30190644

Článek vyšel v časopise


2019 Číslo 10