Electromechanical delay in the left atrium as a consequence of interatrial block

Ramsaran, Eddison; Spodick, David H.

doi:10.1016/s0002-9149(96)00149-x

Cited by 36 publications

(22 citation statements)

References 13 publications

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“…Also, there are some echocardiographic methods to measure interatrial conduction times by the evaluation www.cardiologyjournal.org of cardiac electromechanical events. The time interval between the electrocardiographic P wave and the atrial contraction detected by M-mode or Doppler echocardiography is defined as atrial electromechanical delay [9][10][11]. Atrial mechanical activity can be detected from different atrial regions by tissue Doppler echocardiography with high temporal resolution [12].…”

Section: Introductionmentioning

confidence: 99%

Tissue Doppler echocardiography can be a useful technique to evaluate atrial conduction time

Deniz

Şahiner²,

Aytemir³

et al. 2012

Cardiol J

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Section: Introductionmentioning

confidence: 99%

Tissue Doppler echocardiography can be a useful technique to evaluate atrial conduction time

Deniz

Şahiner²,

Aytemir³

et al. 2012

Cardiol J

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“…10,26 -28 Increased P-wave duration is prevalent, 29,20 associated with left atrial electromechanical dysfunction, and a potential risk of embolism. 31,32 The few studies which have addressed the prognostic value of P-wave changes, were performed in selective and limited populations of patients. Perkiomaki et al 15 studied the independentvalue of ECG variables in predictingcardiac events after acute myocardial infarction.…”

Section: Discussionmentioning

confidence: 99%

The Prognostic Importance of Isolated P‐Wave Abnormalities

Kaykha

Myers

Desser

et al. 2010

Clinical Cardiology

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Background: While certain P-Wave morphologies have been associated with abnormal atrial size and either pulmonary or cardiovascular (CV) disease, their relationship to mortality and specific cause of death has not been reported. Methods: Analyses were performed on the first digitally recorded electrocardiogram (ECG) on 43 903 patients at the Palo Alto Veterans Administration Medical Center since 1987. After appropriate exclusions, 40 020 patients remained. Using computerized algorithms, P-wave amplitude and duration in 12 leads as well as several standardized ECG interpretations were extracted. The main outcome measures were pulmonary and CV mortality. Results: During a mean follow-up of 6 years there were 3417 CV and 1213 pulmonary deaths. After adjusting for age and heart rate in a Cox regression model, P-wave amplitude in the inferior leads was the strongest predictor of pulmonary death (hazard ratio [HR]: 3.0, 95% confidence interval [CI]: 2.3-3.9, P < .0001 for an amplitude >2.5 mm), outperforming all other ECG criteria. The depth of P-wave inversion in leads V 1 or V 2 and P-wave duration were strong predictors of CV death (HR: 1.7, 95% CI: 1.5-2.0, P < 0.0001 for a P-wave inversion deeper than 1 mm), outperforming many previously established ECG predictors of CV death. Conclusions: P-wave amplitude in the inferior leads is the strongest independent predictor of pulmonary death while P-wave duration and the depth of P-wave inversion in leads V 1 or V 2 significantly predict CV death. These measurements can be obtained easily and should be considered as part of clinical risk stratification.

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“…If cardiologists overlook IAB and its significant implications, what more can be expected from general internists whose focus may be on a wide variety of other medical conditions and body systems. Omissions of IAB in both general medicine [11, 12] and cardiology textbooks [13, 14] and lack of understanding and misperception of IAB as an indolent, incidental finding do not help in our efforts towards preventing, and perhaps, decreasing the incidence of the sequelae of IAB, such as atrial tachyarrhythmias [2, 8, 9], LA electromechanical dysfunction and embolism [7]. Given the success of recent multicenter trials with atrial pacing to normalize prolonged P wave duration and possibly avert atrial fibrillation [15], as well as the use of adjunctive angiotensin-converting enzyme inhibitor therapy [16], it is possible that the role of prevention in IAB is beginning to take flight.…”

Section: Discussionmentioning

confidence: 99%

“…The resultant lag in depolarization and the subsequent delayed contraction of the LA is captured on surface electrocardiograms (ECGs; P waves ≥110 ms); usually bifid, it denotes the RA and LA components [3]. IAB is prevalent in the sinus rhythm of more than 40% of patients, as shown in two separate general hospital populations [4, 5]; it is strongly associated with LA enlargement (LAE) [6], LA electromechanical dysfunction and a potential risk of embolism [7]. Most importantly, it is now also common understanding that IAB could be a potent precursor for atrial tachyarrhythmias, mainly atrial fibrillation [2, 8, 9].…”

Section: Introductionmentioning

confidence: 99%

Clinician Underappreciation of Interatrial Block in a General Hospital Population

Ariyarajah¹,

Puri

Spodick

2005

Cardiology

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Introduction: Interatrial block (IAB; P wave ≧110 ms), a conduction delay between the right and left atria (LA), is highly prevalent and strongly associated with atrial tachyarrhythmias, LA electromechanical dysfunction as well as a risk of embolism. Nonetheless, clinicians’ underappreciation of its existence and sequelae remains. We appraised this issue in a general hospital population. Methods: From the database of 730 12-lead electrocardiograms (ECGs) of patients aged 17–98 years (mean age 67.80 years; female patients 53.56%) in a tertiary care teaching general hospital, we recorded the computer-generated diagnostic readings of the ECGs and also the official cardiologist and hospitalist ECG interpretations and documentations. For increased sensitivity and specificity, and because the mode P wave duration in IAB is 120 ms, P waves ≧120 ms in any lead were used to diagnose IAB. Results: Six hundred and fifty-three ECGs (89.45%) showed sinus rhythm, and of those, IAB was documented on 309 ECGs (47.32%). LA enlargement was cited 29 times (3.97%), while possible LA enlargement and biatrial enlargement were cited 17 (2.32%) and 6 times (0.82%), respectively. One cardiologist’s ECG interpretation documented IAB (0.32%), but none of the other medical staff diagnosed IAB or abnormal P wave duration. Conclusion: This study demonstrates to extremes how IAB went undiagnosed in a general hospital population. Until more awareness of IAB is cultivated, such ignorance of the existence and sequelae of IAB could continue. Configuring ECG software to include P wave durations in computer-generated ECG readings could be useful in aiding diagnosis.

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Electromechanical delay in the left atrium as a consequence of interatrial block

Cited by 36 publications

References 13 publications

Tissue Doppler echocardiography can be a useful technique to evaluate atrial conduction time

Tissue Doppler echocardiography can be a useful technique to evaluate atrial conduction time

The Prognostic Importance of Isolated P‐Wave Abnormalities

Clinician Underappreciation of Interatrial Block in a General Hospital Population

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