Advanced interatrial block is a surrogate for left atrial strain reduction which predicts atrial fibrillation and stroke

Abstract

Bayés de Luna et al. described the electrocardiographic and vectocardiographic criteria that identify interatrial block (IAB) and its relationship with atrial fibrillation (AF), as Bayes Syndrome (Conde et al., 2015). There are two types of IAB, partial (pIAB) and advanced (aIAB). In the pIAB, the stimulus is delayed between the two atria, but can cross the septum via the Bachmann's bundle region.In this region, the conduction of the electrical stimulus is totally blocked in patients with aIAB (Bayés de Luna et al., 1988; Figure 1).Transthoracic speckle tracking echocardiography (STE) has shown that a decrease in strain and strain rate (SR) absolute value during the booster pump function phase (SRa) of the left atrial (LA) and during the LA reservoir phase predict the development of new-onset nonvalvular AF (Hirose et al., 2012), progression of paroxysmal AF to persistent or permanent (Yoon,

Association between interatrial block, left atrial fibrosis, and mechanical dyssynchrony: Electrocardiography‐magnetic resonance imaging correlation

“…A‐IAB is a predictor of stroke, 4 incident atrial fibrillation (AF), 5 and AF recurrence after catheter ablation 6,7 . Moreover, in individuals with A‐IAB, low LA strain rate during atrial contraction (Sra) by speckle‐tracking echocardiography predicts incident AF and ischemic stroke 8 . LA volumes, strain, dyssynchrony, and fibrosis are also predictors of stroke, 9,10 incident AF, 11 and AF recurrence after catheter ablation 12‐14 .…”

Advanced interatrial block predicts recurrence of atrial fibrillation after accessory pathway ablation in patients with Wolff‐Parkinson‐White syndrome

“…First, advanced IAB is likely a presentation of AP‐independent atrial electrophysiological abnormalities that remain after successful AP ablation. In support of this, advanced IAB was previously reported to reflect the underlying atrial substrate with atrial fibrosis and to be associated with the development of AF . Second, advanced IAB may play a role in initiating and maintaining reentry circuits by promoting the occurrence of unidirectional block, an important mechanism in the development of AF.…”

“…In support of this, advanced IAB was previously reported to reflect the underlying atrial substrate with atrial fibrosis 27,28 and to be associated with the development of AF. [12][13][14][15][16][17][18][19][20] Second, advanced IAB may play a role in initiating and maintaining reentry circuits by promoting the occurrence of unidirectional block, 29 an important mechanism in the development of Multiple APs, n (%) 5 (4.9%) 0 (0.0%) 5 (5.4%) 1.00…”

“…10 The appearance of advanced IAB is frequently associated with atrial tachyarrhythmias, and has been found to predict AF in multiple clinical scenarios. [12][13][14][15][16][17][18][19][20] However, the role of advanced IAB in predicting the recurrence of AF after AP ablation in patients with WPW syndrome is unclear. Thus, in the present study, we investigated the clinical utility of advanced IAB for predicting the risk of AF recurrence in patients with verified paroxysmal AF and WPW syndrome after successful AP ablation.…”

“…A prolonged P‐wave with biphasic (±) morphology in the inferior leads represents an even higher degree of IAB and has been referred to as advanced IAB . The appearance of advanced IAB is frequently associated with atrial tachyarrhythmias, and has been found to predict AF in multiple clinical scenarios . However, the role of advanced IAB in predicting the recurrence of AF after AP ablation in patients with WPW syndrome is unclear.…”