Atrial dysfunction has been widely considered a marker or consequence of other cardiac conditions rather than the cause itself. Here, we propose the term atrial failure as a clinically relevant ...entity, defined as any atrial dysfunction causing impaired heart performance, symptoms, and worsening quality of life or life expectancy. Aspects of the etiology, mechanisms, and consequences of atrial failure are discussed. Recent advances in cardiac electrophysiology and imaging have improved our understanding of the highly complex atrial anatomy and function, underlying the paramount importance of the atria in optimal heart performance. It is time to reappraise the concept of the failing atrium as a primary cause or aggravating factor of the symptoms in many of our patients. The concept of atrial failure may foster basic and translational research to gain a better understanding of how to identify and manage atrial dysfunction.
Abstract Interatrial block (IAB) represents delay or block of conduction between the atria. IAB has been shown to predict the development or recurrence of atrial fibrillation (AF) in various clinical ...scenarios. Few studies have examined the correlation between coronary artery disease and the prevalence of IAB and its impact on AF. The aim of this study was to determine if specific coronary artery lesions (location and number) are associated with the presence of IAB and development of new-onset AF. Retrospective analysis of patients presenting with NSTEMI to our institution. Data were recorded for clinical, echocardiographic, angiographic, electrocardiographic and outcome variables. Semiautomatic calipers and scanned ECGs at 300 DPI maximized x 8 were used to measure P-wave duration. Follow-up for a minimum of one year. Chi-square tests and independent samples t-tests, which were done using IBM SPSS. A total of 322 patients were included in the analysis. Men 72.3%, mean age 65.4 ± 11.9 years, mean ejection fraction of 55.2 ± 12.7% and mean left atrial diameter of 38.7 ± 6mm. The prevalence of partial IAB was 31.9%, and advanced IAB was 6.5%. Patients with IAB were significantly older (<0.001) and had a greater prevalence of hypertension (0.014). The presence of diffuse coronary artery disease defined as more than one significant coronary artery lesion was associated with IAB (0.026). No specific coronary artery lesion location was found to be associated with IAB nor increased P-wave duration. Patients who developed AF during the follow-up had a significantly higher prevalence of IAB (p=0.021) and also higher prevalence of diffuse coronary artery disease (0.001). IAB is significantly associated with diffuse coronary artery disease in patients with NSTEMI. IAB is significantly associated with the development of new-onset AF within 12-months following NSTEMI.
In this article, we will comment on new aspects of P‐wave morphology that help us to better diagnose atrial blocks and atrial enlargement, and their clinical implications. These include: (1) Atypical ...ECG patterns of advanced interatrial block; (2) The ECG diagnosis of left atrial enlargement versus interatrial block; (3) Atrial fibrillation and advanced interatrial block: The two sides of the same coin; and (4) P‐wave parameters: Clinical implications.
In the present paper, we commented on the new electrocardiographic aspects of the P wave: its value in clinical cardiology. In this figure, we showed an atypical example of an advanced interatrial block that is diagnosed by the presence of the P wave with a duration ≥120 ms plus the P wave with ± morphology in leads II, III, and aVF.
Atypical advanced interatrial block due to giant atrial lipoma Gentille‐Lorente, Delicia Inés; Scott, Laura; Escobar‐Robledo, Luis Alberto ...
Pacing and clinical electrophysiology,
April 2021, 2021-04-00, 20210401, Letnik:
44, Številka:
4
Journal Article
Recenzirano
Keywords: atypical interatrial block for duration; advanced interatrial block; atrial lipoma Byline: Delicia Ines Gentille-Lorente, Laura Scott, Luis Alberto Escobar-Robledo, Maria Antonia Mesa-Maya, ...Francesc Carreras-Costa, Adrian Baranchuk, Manuel Martinez-Selles, Roberto Elosua, Antoni Bayes-Genis, Antoni Bayes-de-Luna
Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with stroke, cognitive impairment, and cardiovascular death. Some predisposing factors - as aging, diabetes, ...hypertension - induce and maintain electrophysiological and ultrastructural remodeling that usually includes fibrosis. Interatrial conduction disturbances play a crucial role in the initiation of atrial fibrosis and in its associated complications. The diagnosis of interatrial blocks (IABs) is easy to perform using the surface ECG. IAB is classified as partial when the P wave duration is ≥120 ms, and advanced if the P wave also presents a biphasic pattern in II, III and aVF. IAB is very frequent in the elderly and, particularly in the case of the advanced type, is associated with AF, AF recurrences, stroke, and dementia. The anticoagulation in elderly patients at high risk of AF without documented arrhythmias is an open issue but recent data suggest that it might have a role, particularly in elderly patients with structural heart disease, high CHA
DS
VASc (Congestive heart failure/left ventricular dysfunction, Hypertension, Age ≥ 75 doubled, Diabetes, Stroke doubled - Vascular disease, Age 65-74, and Sex category female), and advanced IAB. In this debate, we discuss the association of surface ECG IAB, a marker of atrial fibrosis, with AF and stroke. We also present the rationale that justifies further studies regarding anticoagulation in some of these patients.
The two most common modes of death among chronic heart failure (CHF) patients are sudden cardiac death (SCD) and pump failure death (PFD). Periodic repolarization dynamics (PRD) quantifies ...low-frequency oscillations in the T wave vector of the electrocardiogram (ECG) and has been postulated to reflect sympathetic modulation of ventricular repolarization. This study aims to evaluate the prognostic value of PRD to predict SCD and PFD in a population of CHF patients. 20-min high-resolution (1000 Hz) ECG recordings from 569 CHF patients were analyzed. Patients were divided into two groups, Formula: see text and Formula: see text, corresponding to PRD values above and below the optimum cutoff point of PRD in the study population. Univariate Cox regression analysis showed that SCD risk in the Formula: see text group was double the risk in the Formula: see text group hazard ratio (95% CI) 2.001 (1.127-3.554), Formula: see text. The combination of PRD with other Holter-based ECG indices, such as turbulence slope (TS) and index of average alternans (IAA), improved SCD prediction by identifying groups of patients at high SCD risk. PFD could be predicted by PRD only when combined with TS hazard ratio 2.758 (1.572-4.838), Formula: see text. In conclusion, the combination of PRD with IAA and TS can be used to stratify the risk for SCD and PFD, respectively, in CHF patients.
Arrhythmogenic right ventricular dysplasia or cardiomyopathy (ARVD/C) is a pathologic condition where the right ventricle is partially or totally replaced by fatty and fibrous tissue. The ...electrocardiogram (ECG) has a central role for diagnosis since it comprises two major and two minor criteria in the diagnostic criteria published by the Task 1 Force, although it is not 100% necessary to make a final diagnosis, because around 10% of patients with ARVD/C present with a normal ECG. In this article, we review the 12-lead electrocardiographic findings of patients with ARVD/C. ECG criteria observed during depolarization prolonged terminal activation duration, epsilon wave, partial right bundle branch block (RBBB) and advanced RBBB of peripheral origin with characteristic ECG patterns and repolarization abnormalities, (negative T waves) are reviewed in detail. More common ventricular arrhythmias and risk of sudden death, and how to use the surface ECG to stratify the risk, are part of our final comments.
A significant proportion of patients develop atrial fibrillation (AF) following cavotricuspid isthmus (CTI) ablation for typical atrial flutter (AFl). The objective of this study was to assess ...whether the presence of advanced interatrial block (aIAB) was associated with an elevated risk of AF after CTI ablation in patients with typical AFl and no prior history of AF.
This study included patients with typical AFl and no prior history of AF that were referred for CTI ablation. Patients were excluded when they had received repeat ablations or did not demonstrate a bidirectional block. In all patients, a post-ablation electrocardiogram (ECG) in sinus rhythm was evaluated for the presence of aIAB, defined as a P-wave duration ≥120 ms and biphasic morphology in the inferior leads. New-onset AF was identified from 12-lead ECGs, Holter monitoring, and device interrogations. The cohort comprised 187 patients (age 67 ± 10.7 years; ejection fraction 55.8 ± 11.2%). Advanced interatrial block was detected in 18.2% of patients, and left atrium was larger in patients with aIAB compared with those without aIAB (46.2 ± 5.9 vs. 43.1 ± 6.0 mm; P = 0.01). Over a median follow-up of 24.2 months, 67 patients (35.8%) developed new-onset AF. The incidence of new-onset AF was greater in patients with aIAB compared with those without aIAB (64.7 vs. 29.4%; P < 0.001). After a comprehensive multivariate analysis, aIAB emerged as the strongest predictor of new-onset AF odds ratio (OR) 4.2, 95% confidence interval (CI): 1.9-9.3; P < 0.001.
Advanced interatrial block is a key predictor for high risk of new-onset AF after a successful CTI ablation in patients with typical AFl.
The diagnosis of advanced interatrial block (A-IAB) is done by surface ECG analysis when the P-wave ≥120 ms with biphasic (±) morphology in leads II, III and aVF. In this brief communication, we ...advance a new concept involving atypical patterns of A-IAB due to changes about the morphology or duration of the P-wave. It remains to be determined its real prevalence in different clinical scenarios, and whether these atypical ECG patterns should be considered as predictors of atrial fibrillation/stroke.
When making medical decisions, whether for diagnostic or for therapeutic purposes, having the best and most up-to-date information is of the utmost importance. Because heart diseases often involve ...emergencies that require urgent diagnosis and treatment, the cardiologist represents the paradigm of the health care provider who requires updated training and information. Things have evolved rapidly, and nowadays information is spread through a myriad of multimedia methods. ...we can have immediate updates on all of the major advances in new diagnostic methods and available treatments for cardiovascular diseases. The role of the editorialist is not only to perform a critical review of the paper, but also to emphasize some specific aspects of the diagnosis and treatment of cardiovascular disease that may be particularly important for each geographical zone.
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