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Intra- and interatrial conduction abnormalities: hemodynamic and arrhythmic significance

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Abstract

Alterations of normal intra- and interatrial conduction are a common outcome of multiple cardiovascular conditions. They arise most commonly in the context of advanced age, cardiovascular risk factors, organic heart disease, atrial fibrosis, and left atrial enlargement. Interatrial block (IAB), the most frequent and extensively studied atrial conduction disorder, affects up to 20% of the general primary care population. IAB can be partial (P wave duration ≥ 120 ms on any of the 12 ECG leads) or advanced (P wave ≥ 120 ms and biphasic morphology (positive-negative) in inferior leads). Advanced IAB is an independent risk factor for supraventricular tachyarrhythmias and embolic stroke in a variety of clinical settings. Advanced IAB is a cause of left atrial electromechanical dysfunction and left atrioventricular dyssynchrony and has been associated with left ventricular diastolic dysfunction. P wave duration is associated with cardiovascular and all-cause mortality in the general population. Atrial conduction abnormalities should be identified as markers of atrial remodeling, prognostic indicators, and, in the case of advanced IAB, a true arrhythmologic syndrome. IAB and other P wave abnormalities should prompt the search for associated conditions, the treatment of which may partially reverse atrial remodeling or prevent it if administered upstream. Future studies will help define the role of preventive therapeutic interventions in high-risk patients, including antiarrhythmic drug therapy and oral anticoagulation. Implications for the treatment of heart failure and for pacing should also be further investigated.

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Abbreviations

ACEI:

Angiotensin-converting enzyme inhibitor

aIAB:

Advanced interatrial block

AF:

Atrial fibrillation

ARB:

Angiotensin-II receptor blocker

AV:

Atrioventricular

CPAP:

Continuous positive airway pressure

CRT:

Cardiac resynchronization therapy

ECG:

Electrocardiogram

IAB:

Interatrial block

LA:

Left atrium

LAE:

Left atrial enlargement

LV:

left ventricle

OSA:

Obstructive sleep apnea

pIAB:

Partial interatrial block

PWD:

P wave dispersion

RA:

Right atrium

SA:

Sino-atrial

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The authors are supported by the Swiss National Science Foundation.

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  1. Cardiology Division, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland

    Nicolas Johner, Mehdi Namdar & Dipen C. Shah

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  1. Nicolas Johner
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Johner, N., Namdar, M. & Shah, D.C. Intra- and interatrial conduction abnormalities: hemodynamic and arrhythmic significance. J Interv Card Electrophysiol 52, 293–302 (2018). https://doi.org/10.1007/s10840-018-0413-4

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