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Advanced interatrial block independently predicts appropriate and inappropriate ICD therapies in hypertrophic

Nizamettin Selçuk Yelgeç1, Can Baba Arın2, Ayşegül Aygün2

  • 1Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey. yelgec@gmail.com.

Herz
|April 28, 2026
PubMed

Insights

Advanced interatrial block (IAB) independently predicts both appropriate and inappropriate implantable cardioverter-defibrillator (ICD) shocks in hypertrophic cardiomyopathy (HCM) patients. This ECG finding aids in risk stratification for ICD therapy.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Diagnostics

Background:

  • Implantable cardioverter-defibrillators (ICDs) are crucial for preventing sudden cardiac death in hypertrophic cardiomyopathy (HCM).
  • Both appropriate and inappropriate ICD shocks have significant clinical consequences.
  • The prognostic value of advanced interatrial block (IAB), an ECG marker of atrial conduction disease, in HCM patients receiving ICDs is not well understood.

Purpose of the Study:

  • To investigate the association between advanced IAB and the risk of appropriate and inappropriate ICD shocks in patients with HCM.
  • To determine if advanced IAB is an independent predictor of ICD shocks in this population.

Main Methods:

  • Retrospective analysis of 184 HCM patients who underwent ICD implantation (2014-2024).
  • Advanced IAB defined by P-wave duration (≥120 ms) and morphology in inferior leads.
  • Kaplan-Meier analysis and Cox regression assessed time to first ICD shock.

Main Results:

  • Patients with advanced IAB had significantly lower shock-free survival for both appropriate and inappropriate shocks.
  • Advanced IAB independently predicted appropriate ICD shocks (HR: 6.03) and inappropriate shocks (HR: 3.50).
  • Non-sustained ventricular tachycardia, left atrial diameter, atrial fibrillation, and age were also associated with ICD shocks.

Conclusions:

  • Advanced IAB is an independent risk factor for both appropriate and inappropriate ICD shocks in HCM patients.
  • This ECG marker can improve risk stratification for ICD recipients with HCM.
  • Findings may inform ICD programming and follow-up strategies.
Abstract

Keywords:
Atrial fibrillationHypertrophic cardiomyopathyImplantable cardioverter-defibrillatorInappropriate shocksRisk stratification

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