scholarly journals The Syndrome Of Inter-Atrial Conduction Block

2015 ◽  
Vol 10 (2) ◽  
pp. 74 ◽  
Author(s):  
Velislav N Batchvarov ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Conduction Block ◽  
Future Directions ◽  
Potential Benefits ◽  
Prospective Trials ◽  
Interatrial Block ◽  
Ecg Leads ◽  
Electrocardiogram Ecg ◽  
Antiarrhythmic Treatment ◽  
Interatrial Conduction

The formulation of the syndrome of interatrial conduction block is an important step for improved identification of patients at high risk of developing atrial fibrillation (those with advanced, that is, third degree interatrial block, which includes retrograde instead of normal activation of the left atrium). The rationale and potential benefits of prophylactic antiarrhythmic treatment of patients with advanced interatrial block currently seems not sufficiently convincing and requires further study including prospective trials. In addition to the identified future directions for research in this syndrome, it seems important also to explore novel electrocardiogram (ECG) methods (e.g. new electrode positions and ECG leads) for improved characterisation of the atrial electrical events. Oesophageal electrocardiography and vectorcardiography are old, venerable and unjustifiably forgotten ECG techniques: their additional use of for better diagnosis of interatrial conduction block is highly commendable.

scholarly journals The Diagnosis and Clinical Implications of Interatrial Block

2015 ◽  
Vol 10 (1) ◽  
pp. 54 ◽  
Author(s):  
Antonio Bayés de Luna ◽  
Albert Massó-van Roessel ◽  
Luis Alberto Escobar Robledo ◽  
◽  
◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Left Atrial ◽  
Conduction Block ◽  
Clinical Implications ◽  
Left Atrial Enlargement ◽  
The Third ◽  
Atrial Enlargement ◽  
Interatrial Block ◽  
Interatrial Conduction

Impaired interatrial conduction or interatrial block is now well-documented but is not described as an individual electrocardiographic (ECG) pattern in the majority of ECG literature. In fact the term atrial abnormality has been adopted to encompass both left atrial enlargement (LAE) and interatrial block. In this paper, we maintain that interatrial blocks and atrial enlargement are separate entities, and that interatrial blocks, similar to other types of blocks at sinoatrial, AV junctional, and ventricular level, exhibit a specific ECG pattern that may present first, second, and third degree types of conduction block. The third degree or advanced interatrial block (A-IAB) is frequently associated with atrial fibrillation/atrial flutter (AF/AFl), and constitutes a true newly-described syndrome.

scholarly journals Subclinical and Asymptomatic Atrial Fibrillation: Current Evidence and Unsolved Questions in Clinical Practice

Medicina ◽  
2019 ◽  
Vol 55 (8) ◽  
pp. 497
Author(s):  
Andrea Ballatore ◽  
Mario Matta ◽  
Andrea Saglietto ◽  
Paolo Desalvo ◽  
Pier Paolo Bocchino ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Control Strategies ◽  
Rhythm Control ◽  
Current Evidence ◽  
Individual Risk ◽  
Stroke Incidence ◽  
Asymptomatic Patients ◽  
Potential Benefits ◽  
Electrocardiogram Ecg

Atrial Fibrillation (AF) may be diagnosed due to symptoms, or it may be found as an incidental electrocardiogram (ECG) finding, or by implanted devices recordings in asymptomatic patients. While anticoagulation, according to individual risk profile, has proven definitely beneficial in terms of prognosis, rhythm control strategies only demonstrated consistent benefits in terms of quality of life. In fact, evidence collected by observational data showed significant benefits in terms of mortality, stroke incidence, and prevention of cognitive impairment for patients referred to AF catheter ablation compared to those medically treated, however randomized trials failed to confirm such results. The aims of this review are to summarize current evidence regarding the treatment specifically of subclinical and asymptomatic AF, to discuss potential benefits of rhythm control therapy, and to highlight unclear areas.

scholarly journals Magnetic Resonance Guided Radiation Therapy for Pancreatic Adenocarcinoma, Advantages, Challenges, Current Approaches, and Future Directions

2021 ◽  
Vol 11 ◽  
Author(s):  
William A. Hall ◽  
Christina Small ◽  
Eric Paulson ◽  
Eugene J. Koay ◽  
Christopher Crane ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Pancreatic Adenocarcinoma ◽  
New Technology ◽  
Level Of Evidence ◽  
Future Directions ◽  
Mr Guidance ◽  
Long Term Follow Up ◽  
Potential Benefits ◽  
Prospective Trials ◽  
International Experts

IntroductionPancreatic adenocarcinoma (PAC) has some of the worst treatment outcomes for any solid tumor. PAC creates substantial difficulty for effective treatment with traditional RT delivery strategies primarily secondary to its location and limited visualization using CT. Several of these challenges are uniquely addressed with MR-guided RT. We sought to summarize and place into context the currently available literature on MR-guided RT specifically for PAC.MethodsA literature search was conducted to identify manuscript publications since September 2014 that specifically used MR-guided RT for the treatment of PAC. Clinical outcomes of these series are summarized, discussed, and placed into the context of the existing pancreatic literature. Multiple international experts were involved to optimally contextualize these publications.ResultsOver 300 manuscripts were reviewed. A total of 6 clinical outcomes publications were identified that have treated patients with PAC using MR guidance. Successes, challenges, and future directions for this technology are evident in these publications. MR-guided RT holds theoretical promise for the treatment of patients with PAC. As with any new technology, immediate or dramatic clinical improvements associated with its use will take time and experience. There remain no prospective trials, currently publications are limited to small retrospective experiences. The current level of evidence for MR guidance in PAC is low and requires significant expansion. Future directions and ongoing studies that are currently open and accruing are identified and reviewed.ConclusionsThe potential promise of MR-guided RT for PAC is highlighted, the challenges associated with this novel therapeutic intervention are also reviewed. Outcomes are very early, and will require continued and long term follow up. MR-guided RT should not be viewed in the same fashion as a novel chemotherapeutic agent for which dosing, administration, and toxicity has been established in earlier phase studies. Instead, it should be viewed as a novel procedural intervention which must be robustly tested, refined and practiced before definitive conclusions on the potential benefits or detriments can be determined. The future of MR-guided RT for PAC is highly promising and the potential implications on PAC are substantial.

scholarly journals Ischemic stroke in a patient with interatrial block: Is it only a coincidence or a clear relationship?

2021 ◽  
Vol 91 (2) ◽  
Author(s):  
Athanassios Antonopoulos ◽  
Laila Fiorani
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Case Report ◽  
Early Identification ◽  
Conduction Block ◽  
Embolic Stroke ◽  
P Wave ◽  
Wave Analysis ◽  
Increased Risk ◽  
Interatrial Block

Atrial fibrillation (AF) can be detected in nearly 25% of all patients with stroke by sequentially combining different electrocardiographic methods. Prediction of early cardio-embolic stroke remain a permanent challenge in everyday practice. The early identification of an increased risk for atrial fibrillation episodes (which are frequently asymptomatic) is essential for the prevention of cardioembolic events. One of the noninvasive modalities of atrial fibrillation prediction is represented by the electrocardiographic P-wave analysis. This includes study and diagnosis of interatrial conduction block. Our short case report presents a case with ischemic cortico-sottocortical stroke involving capsulo and caudo regions in a woman patient with interatrial block as realized by electrocardiographic P analysis.  

scholarly journals Second-Degree Interatrial Block in Hemodialysis Patients

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Andres Enriquez ◽  
Marco Marano ◽  
Anna D’Amato ◽  
Antoni Bayes de Luna ◽  
Adrian Baranchuk
Keyword(s):  
Conduction Block ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
P Wave ◽  
Wave Duration ◽  
P Wave Duration ◽  
Surface Ecg ◽  
Interatrial Block ◽  
Bachmann Bundle ◽  
Interatrial Conduction

Interatrial conduction delays manifest as a prolonged P-wave duration on surface ECG and the term interatrial block (IAB) has been coined. They are usually fixed, but cases of intermittent IAB have been described, suggesting functional conduction block at the Bachmann bundle region. We report 2 cases of patients on chronic hemodialysis therapy presenting with intermittent IAB.

Advanced interatrial block precedes atrial fibrillation and stroke. The prospective interatrial Block And Yearly EventS (BAYES) registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Martinez-Selles ◽  
R Elosua ◽  
M Ibarrola ◽  
M De Andres ◽  
P Diez-Villanueva ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Sinus Rhythm ◽  
Structural Heart Disease ◽  
P Wave ◽  
Wave Duration ◽  
P Wave Duration ◽  
Previous Diagnosis ◽  
Surface Ecg ◽  
Interatrial Block

Abstract Background Advanced interatrial block (IAB), prolonged and bimodal P waves in surface ECG inferior leads, is an unrecognized surrogate of atrial dysfunction and a trigger of atrial dysrhythmias, mainly atrial fibrillation (AF). Our aim was to prospectively assess whether advanced IAB in sinus rhythm precedes AF and stroke in elderly outpatients with structural heart disease, a group not previously studied. Methods Prospective observational registry that included outpatients aged ≥70 years with structural heart disease and no previous diagnosis of AF. Patients were divided into three groups according to P-wave characteristics. Results Among 556 individuals, 223 had normal P-wave (40.1%), 196 partial IAB (35.3%), and 137 advanced IAB (24.6%). After a median follow-up of 694 days; 93 patients (16.7%) developed AF, 30 stroke (5.4%), and 34 died (6.1%). Advanced IAB was independently associated with AF (hazard ratio [HR] 2.9, 95% confidence interval [CI] 1.7–5.1, p<0.001), stroke (HR 3.8, 95% CI 1.4–10.7, p=0.010), and AF/stroke (HR 2.6, 95% CI 1.5–4.4, p=0.001). P-wave duration (ms) was independently associated with AF (HR 1.05, 95% CI 1.03–1.07, p<0.001), AF/stroke (HR 1.04, 95% CI 1.02–1.06, p<0.001), and mortality (HR 1.04, 95% CI 1.00–1.08, p=0.021). Conclusions The presence of advanced IAB in sinus rhythm is a risk factor for AF and stroke in an elderly population with structural heart disease and no previous diagnosis of AF. P-wave duration was also associated with all-cause mortality. Figure. Age- and sex-adjusted linear and non-linear association between P-wave duration (msec) and atrial fibrillation (A), stroke (B), and atrial fibrillation or stroke (C) risk. Results of a generalized additive model with spline smoothing functions and 4 degrees of freedom. Figure 1. Kaplan-Meyer curves of survival free of atrial fibrillation (A), stroke (B) and atrial fibrillation or stroke (C) in patients with normal P-wave, partial interatrial block (IAB) and advanced IAB. Funding Acknowledgement Type of funding source: None

Heart failure and atrial fibrillation: new concepts in pathophysiology, management, and future directions

2021 ◽  
Author(s):  
Grigorios Tsigkas ◽  
Anastasios Apostolos ◽  
Stefanos Despotopoulos ◽  
Georgios Vasilagkos ◽  
Eleftherios Kallergis ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Future Directions ◽  
New Concepts

scholarly journals Screening for atrial fibrillation during automated blood pressure measurement among patients admitted to internal medicine ward

2021 ◽  
Author(s):  
Giacomo Pucci ◽  
Edoardo Santoni ◽  
Valeria Bisogni ◽  
Camilla Calandri ◽  
Alberto Cerasari ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Adult Population ◽  
Blood Pressure Measurement ◽  
University Hospital ◽  
Daily Routine ◽  
Internal Medicine Ward ◽  
Clinical Conditions ◽  
Electrocardiogram Ecg

AbstractAtrial fibrillation (AF), the commonest sustained cardiac arrhythmia affecting the adult population, is often casually discovered among hospitalized people. AF onset is indeed triggered by several clinical conditions such as acute inflammatory states, infections, and electrolyte disturbance, frequently occurring during the hospitalization. We aimed to evaluate whether systematic AF screening, performed through an automated oscillometric blood pressure (BP) device (Microlife WatchBP Office AFIB, Microlife AG, Switzerland), is effective for detecting AF episodes in subjects admitted to an Internal Medicine ward. 163 patients consecutively hospitalized at the Unit of Internal Medicine of the “Santa Maria” Terni University Hospital between November 2019 and January 2020 (mean age ± standard deviation: 77 ± 14 years, men proportion: 40%) were examined. Simultaneously with BP measurement and AF screening, a standard 12-lead electrocardiogram (ECG) was performed in all subjects. AF was diagnosed by ECG in 29 patients (18%). AF screening showed overall 86% sensitivity and 96% specificity. False negatives (n = 4) had RR-interval coefficient of variation lower than true positives (n = 25, p < 0.01), suggesting a regular ventricular rhythm during AF. The repeated evaluation substantially confirmed the same level of agreement. AF screening was positive in all patients with new-onset AF (n = 6, 100%). Systematic AF screening in patients admitted to Internal Medicine wards, performed using the Microlife WatchBP Office AFIB, is feasible and effective. The opportunity to implement such technology in daily routine clinical practice to prevent undiagnosed AF episodes in hospitalized patients should be the subject of further research.

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