Advanced interatrial block predicts recurrence of embolic stroke of undetermined source

Carrillo-Loza, Karina; Baranchuk, Adrián; Serrano, Fabiola; Hasseb, S.; Lira, F.; Soriano, Emil Moronta; Araúz, Antonio

doi:10.1016/j.nrleng.2019.10.008

Cited by 3 publications

(3 citation statements)

References 31 publications

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“…Previously, it was found to be associated with significant endpoints such as AF, ischemic stroke, and mesenteric embolism. Carrillo-Loza et al 10 showed it to have a robust predictive property in predicting recurrent stroke in strokes of unknown origin.…”

Section: Discussionmentioning

confidence: 99%

Interatrial blocks in patients with tavi and their associations with clinic parameters

Alıç¹,

Yetişen²,

Savcılıoğlu³

et al. 2023

JCCVS

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Aims: The present study attempted to evaluate the prevalence of basal interatrial blocks (IABs), their associations with clinical parameters, and the interatrial conduction in the follow-up after a successful transcatheter aortic valve implantation (TAVI) procedure among patients with severe aortic stenosis. Methods: We retrospectively evaluated the findings of 90 patients undergoing TAVI in our center. Overall, we considered the presence and grades of IABs and P-wave durations in electrocardiograms (ECG), preoperative echocardiography (ECHO) findings (maximum and mean gradients and left atrium (LA) diameter), valve size and type, and changes in these parameters at sixth month. Results: Forty-six patients were included in the study which are suitable for the pre-determined inclusion criteria. We found the mean age of the patients to be 74.78 ± 8.66 years. In preoperatively-evaluated ECGs, while we detected partial IABs in 37% of the patients, there were advanced IABs in 6.5%, but 56.5% yielded no interatrial conduction disorder. On the other hand, in postoperatively-evaluated ECGs, while we observed partial IABs in 30.4% of the patients, there were advanced IABs among 21.7% (p = 0.017). Nevertheless, we could not conclude any IABs among 47.8% of the patients. Besides, 54.3% of the patients received a self-expandable valve, and a balloon-expandable valve was inserted in 45.7%. In this regard, we detected partial (7 patients) and advanced (2 patients) IABs in the preoperatively-evaluated ECGs of the patients receiving a self-expandable valve. In the postoperative ECGs of these patients, while the partial IAB remained the same in 4 patients (57.1%), it progressed to an advanced IAB in 3 (42.9%). In addition, while the advanced IAB regressed to a partial IAB in one patient, it remained the same for the other patient. In this group, the mean P-wave durations were found to be 118.4±22.67 before the TAVI and 119.6±21.69 after the TAVI (p = 0.113). In the preoperative ECGs of 21 patients with a balloon-expandable valve, we detected partial IABs in 10 patients and an advanced IAB in one patient. While a partial IAB developed in five patients (p = 0.022), five patients with a partial IAB developed an advanced IAB following the procedure (p = 0.022). In this group, we noticed a significant difference between preoperative (127.62±19.4) and postoperative (138.71+ 32.03) P-wave durations (p = 0.038). Conclusion: In a nutshell, we concluded no significant change in interatrial conduction time of the patients with TAVI compared to the baseline in their sixth-month ECGs. When considered by valve type, we concluded that the development and progression of IABs were significant among those with a balloon-expandable valve. The higher postoperative mean gradient among those with a balloon-expandable valve compared to those with a self-expandable valve may be associated with significantly longer P-wave duration among those with a balloon-expandable valve.

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Section: Discussionmentioning

confidence: 99%

Interatrial blocks in patients with tavi and their associations with clinic parameters

Alıç¹,

Yetişen²,

Savcılıoğlu³

et al. 2023

JCCVS

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“…The association between advanced IAB and stroke has been demonstrated in different settings and conditions, including the general population, very elderly patients, and patients with high CHADS2 score 4,14 . Also in patients with a history of an embolic stroke of unknown source, advanced IAB predicted the recurrence of a cerebrovascular event 15 .…”

Section: Iabs and Strokementioning

confidence: 99%

Neurological complications of interatrial blocks and BayesÓ? syndrome

Farina¹,

Miranda-Arboleda²,

Lomini³

et al. 2022

RMN

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Interatrial blocks (IABs) are a variety of abnormalities in the interatrial conduction. Bayes' syndrome is a clinical entity based on the association between advanced IABs and supraventricular tachyarrhythmias, being atrial fibrillation (AF) the most frequent. Due to its negative effects on left atrial electromechanical function, both IABs and Bayes' syndrome are associated with thromboembolic phenomena, causing cardiovascular and neurological complications. In regard to neurological involvement, patients with these conditions have an increased incidence of ischemic events, cognitive impairment, and dementia. These observations triggered the question whether the use of early anticoagulation therapy (before the documentation of AF) could prevent thromboembolic events in patients with IABs diagnosis. This review aims to summarize the most recent evidence describing the association of IABs and Bayes' syndrome with neurological events. Potential early therapeutic options to prevent these undesirable clinical consequences will be also discussed.

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“…В упрощенном варианте выделяют частичную межпредсердную блокаду (расширение зубца Р более 120 мс без изменения его морфологии) и далекозашедшую -расширение зубца Р более 120 мс с изменением его морфологии (двухфазный Р с отрицательной частью, связанной с ретроградным возбуждением левого предсердия). Далекозашедшая меж предсердная блокада (ДЗМПБ) имеется у 6,7-23,3% пациентов с ESUS, она является предиктором рецидива инсульта (ОР 10,9) и выявления ФП на повторных 24-часовых ХМ-ЭКГ (ОР 7,5) [25,26].…”

Section: концепция предсердной кардиопатииunclassified

Cryptogenic stroke. Part 3: atrial cardiopathy and silent atrial fibrillation

et al. 2022

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Atrial cardiopathy (AC) and silent atrial fibrillation (AF) are potential causes of embolic cryptogenic stroke (embolic stroke of undetermined source, ESUS) timely diagnosis of which can significantly change the direction of secondary prevention and reduce the risk of repeated brain catastrophe. The article discusses clinical and radiological markers of cardioembolism, the concept of atrial cardiopathy, its electrocardiographic, echocardiographic and serum markers, as well as the possibility of drug prophylaxis of recurrent stroke. The most applicable AC features in daily operation are the ECG data (p-wave terminal force in lead V1 > 5000 μV x ms, supraventricular extrasystoles and advanced interatrial block), 24-hour ECG monitoring (≥ 480 supraventricular extrasystoles per 24-hour, paroxysms of supraventricular tachycardia ≥ 20 complexes), transthoracic (diameter of left atrium > 40 mm, index of diameter of left atrium ≥ 3 cm/m2, index of volume of left atrium > 34 ml/m2) and transesophageal echocardiography (spontaneous echo contrast phenomenon, blood flow rate in LA appendage <20 cm/s) and NT-proBNP concentration > 250 pg/ml. An individual, interdisciplinary decision to prescribe an anticoagulant when combined: (1) the presence of structural and functional AC markers, (2) cardioembolic pattern of a cerebral infarction or intracranial artery occlusion by visualization data and (3) high thromboembolic risk and probability of detection of AF on assessment scales (CHA2DS2-VASc, AF-ESUS and C2HEST). The greatest benefit of prescribing anticoagulant therapy can be obtained by patients with recurrent ESUS in whom sufficient secondary prevention and expressed AC, typical cardioembolism imaging pattern and high risk of thromboembolic events have already been achieved.

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Advanced interatrial block predicts recurrence of embolic stroke of undetermined source

Cited by 3 publications

References 31 publications

Interatrial blocks in patients with tavi and their associations with clinic parameters

Interatrial blocks in patients with tavi and their associations with clinic parameters

Neurological complications of interatrial blocks and BayesÓ? syndrome

Cryptogenic stroke. Part 3: atrial cardiopathy and silent atrial fibrillation

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