Cardiovascular Complications of Interatrial Conduction Block

Power, David; Lampert, Joshua; Camaj, Anton; Bienstock, Solomon; Kocovic, Nikola; Bayés‐Genís, Antoni; Miller, Marc A.; Bayés-de-Luna, Antoni; Fuster, Valentín

doi:10.1016/j.jacc.2022.01.030

Cited by 24 publications

(41 citation statements)

References 83 publications

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“…Interatrial block is a distinct electrocardiographic pattern describing the conduction delay between the right and left atria through Bachmann's bundle 18 . Histologic studies have identified atrial fibrosis as the pathological substrate of interatrial block 18 .…”

Section: Discussionmentioning

confidence: 99%

“…17 The prevalence of rSr' pattern in V1-V2 with a normal QRS Interatrial block is a distinct electrocardiographic pattern describing the conduction delay between the right and left atria through Bachmann's bundle. 18 Histologic studies have identified atrial fibrosis as the pathological substrate of interatrial block. 18 Advanced age, systemic hypertension, coronary artery disease, obstructive sleep apnea, cardiac amyloid and catheter ablation along with genetic susceptibility are known risk factors for interatrial blocks.…”

Section: Electrocardiographic Variables Associated With Underlying Br...mentioning

confidence: 99%

“…18 Histologic studies have identified atrial fibrosis as the pathological substrate of interatrial block. 18 Advanced age, systemic hypertension, coronary artery disease, obstructive sleep apnea, cardiac amyloid and catheter ablation along with genetic susceptibility are known risk factors for interatrial blocks. 18 Underlying BrS/DI-Type 1 BrP may be an additional contributing factor for interatrial block and generation of reentrant circuits in AVNRT.…”

Section: Electrocardiographic Variables Associated With Underlying Br...mentioning

confidence: 99%

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Electrocardiographic variables associated with underlying Brugada syndrome or drug‐induced Type 1 Brugada pattern in patients with slow/fast atrioventricular nodal reentrant tachycardia

Hasdemir

Şahin

Duran

et al. 2022

Journal of Arrhythmia

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Background The coexistence of clinical atrioventricular nodal reentrant tachycardia (AVNRT) and drug‐induced type 1 Brugada pattern (DI‐Type 1 BrP) has been previously reported. The present study was designed to determine the 12‐lead ECG characteristics at baseline and during AVNRT and to identify a subset of 12‐lead ECG variables of benefit associated with underlying Brugada syndrome (BrS)/DI‐Type 1 BrP among patients with slow/fast AVNRT. Methods A total of 40 (11 numerical/29 categorical) 12‐lead ECG parameters were analyzed and compared between patients with (n = 69) and without (n = 104) BrS/DI‐Type1‐BrP matched for age, female gender, body mass index, left ventricular ejection fraction and comorbid conditions. Five distinct types of ECG pattern (Type A/B/C/D/E) in V1–V2 leads during AVNRT were defined. Results A total of nine electrocardiographic variables, four at baseline, and five during AVNRT were identified. At baseline, patients with BrS/DI‐Type 1 BrP had higher prevalence of interatrial block, leftward shift of frontal plane QRS axis, the absence of normal QRS pattern (the presence of rSr’ pattern or type 2/3 Brugada pattern) in V1–V2 and QRS fragmentation in inferior leads compared to patients without BrS/DI‐Type 1 BrP. During AVNRT, patients with BrS/DI‐Type 1 BrP had higher prevalence of Type A ECG pattern (“coved‐type” ST‐segment elevation) in V1–V2, Type C ECG pattern (pseudo‐r’ deflection in V1 and “RBBB‐like” pattern in V2), pseudo‐r’ deflection in V1, QRS fragmentation in inferior leads and “isolated” QRS fragmentation/notching/slurring in aVL compared to patients without BrS/DI‐Type 1 BrP. Conclusions We identify several electrocardiographic variables that point to an underlying type 1 BrP among patients with slow/fast AVNRT.

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Section: Discussionmentioning

confidence: 99%

Section: Electrocardiographic Variables Associated With Underlying Br...mentioning

confidence: 99%

Section: Electrocardiographic Variables Associated With Underlying Br...mentioning

confidence: 99%

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Electrocardiographic variables associated with underlying Brugada syndrome or drug‐induced Type 1 Brugada pattern in patients with slow/fast atrioventricular nodal reentrant tachycardia

Hasdemir

Şahin

Duran

et al. 2022

Journal of Arrhythmia

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“…С точки зрения стратегии, наличие полной МПБ, которая является независимым предиктором рецидива ФП, предполагает выбор клинического решения с рассмотрением для некоторых пациентов тактики контроля ритма или частоты сердечных сокращений. Пациенты с полной МПБ даже при отсутствии эпизодов документированной ФП в анамнезе также имеют более высокий риск тромбоэмболического инсульта, особенно при наличии дополнительных факторов риска, таких как пожилой возраст, сахарный диабет, артериальная гипертензия, структурные заболевания сердца и частая наджелудочковая экстрасистолия [30]. Тем не менее, к настоящему времени пока не приняты клинические рекомендации, которые бы поддерживали стратегию использования антикоагулянтов при отсутствии подтвержденной ФП.…”

Section: Ptfv1unclassified

New Clinical Bayes Syndrome: Definitions, Epidemiology and Clinical Significance

Вайханская¹,

Фролов²

2023

Кардиология В Беларуси

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Байес синдром – это новый клинический симптомный фенотип, характеризующийся сочетанием далеко зашедшей межпредсердной блокады (МПБ), регистрируемой на поверхностной электрокардиограмме, с предсердными тахиаритмиями (фибрилляция или трепетание предсердий). Этот синдром связан с повышенным риском инсульта, деменции и смертности. МПБ 3-й степени представляет собой полную блокаду пучка Бахмана, приводящую к ретроградной деполяризации левого предсердия, что сопровождается расширением зубца Р более 120 мс и двухфазной морфологией P-волны в нижних отведениях ЭКГ. Анатомическим субстратом МПБ является фиброз предсердий, приводящий к изменению структуры и электромеханической дисфункции предсердий (предсердная кардиомиопатия), к застою крови и гиперкоагуляции, потенциально приводящих к запуску тромбогенного каскада. Диссинхрония активации предсердий, вызваннаяМПБ, также является триггерным и поддерживающим механизмом фибрилляции предсердий (ФП). Однако МПБ с предсердной дилатацией даже у пациентов без документального подтверждения предсердных тахиаритмий (по данным многоцентровых исследований) ассоциируются с ФП, инсультом, деменцией и смертностью. Поэтому у пациентов с МПБ рекомендован активный поиск эпизодов ФП с целью своевременного превентивного назначения антикоагулянтов. Bayes syndrome is a new clinical symptomatic phenotype characterized by the combination of advanced interatrial block (IAB) on a surface electrocardiogram with atrial tachyarrhythmias (atrial fibrillation or flutter). This syndrome is associated with an increased risk of stroke, dementia, and mortality. Advanced IAB is a complete Bachmann bundle block resulting in retrograde depolarization of the left atrium, accompanied by P-wave prolongation of more than 120 ms and biphasic P-wave morphology in the inferior ECG leads. The anatomical substrate of IAB is atrial fibrosis, which leads to changes in the structure and electromechanical dysfunction of the atria (atrial cardiomyopathy), to blood stasis and hypercoagulation with a potential triggering off thrombogenic cascade. Atrial activation dyssynchrony caused by IAB is the trigger and supporting mechanism of atrial fibrillation (AF). However, IAB with atrial dilatation, even in patients without documented evidence of atrial tachyarrhythmias (according to multicenter studies), is associated with AF, stroke, dementia, and mortality. Therefore, in patients with IAB, an active AF search is recommended in order to prescribe preventive anticoagulants.

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“…At the same time, the presence of a P-wave duration ≥ 120 ms and an advanced interatrial block was associated with a higher likelihood for subsequent stroke, particularly of cardioembolic origin. The occurrence of an advanced interatrial block by itself is also associated with both the incidence of AF and the incidence of thromboembolic events ( 25 , 38 ). Higher body mass index (BMI) and older age correlate with prolonged P-wave duration and abnormal PTFV1, whereas higher blood pressure correlate with prolonged P-wave duration and right P-wave axis deviation ( 39 ) ( Figures 2B,D ).…”

Section: Electrocardiographymentioning

confidence: 99%

Left Atrial Cardiomyopathy – A Challenging Diagnosis

Kreimer

Gotzmann

2022

Front. Cardiovasc. Med.

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Left atrial cardiomyopathy (LACM) has been an ongoing focus of research for several years. There is evidence that LACM is responsible for atrial fibrillation and embolic strokes of undetermined sources. Therefore, the correct diagnosis of LACM is of clinical importance. Various techniques, including electrocardiography, echocardiography, cardiac magnetic resonance imaging, computed tomography, electroanatomic mapping, genetic testing, and biomarkers, can both identify and quantify structural, mechanical as well as electrical dysfunction in the atria. However, the question arises whether these techniques can reliably diagnose LACM. Because of its heterogeneity, clinical diagnosis is challenging. To date, there are no recommendations for standardized diagnosis of suspected LACM. However, standardization could help to classify LACM more precisely and derive therapeutic directions to improve individual patient management. In addition, uniform diagnostic criteria for LACM could be important for future studies. Combining several parameters and relating them seems beneficial to approach the diagnosis of LACM. This review provides an overview of the current evidence regarding the diagnosis of LACM, in which several potential parameters are discussed and, consequently, a proposal for a diagnostic algorithm is presented.

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Cardiovascular Complications of Interatrial Conduction Block

Cited by 24 publications

References 83 publications

Electrocardiographic variables associated with underlying Brugada syndrome or drug‐induced Type 1 Brugada pattern in patients with slow/fast atrioventricular nodal reentrant tachycardia

Electrocardiographic variables associated with underlying Brugada syndrome or drug‐induced Type 1 Brugada pattern in patients with slow/fast atrioventricular nodal reentrant tachycardia

New Clinical Bayes Syndrome: Definitions, Epidemiology and Clinical Significance

Left Atrial Cardiomyopathy – A Challenging Diagnosis

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