Interatrial block (IAB), prolonged conduction between the atria, is denoted by P waves of 110 milliseconds or more and may manifest as partial or advanced. Theoretically, partial IAB may progress to its advanced counterpart if conduction delay increases to complete block. However, there have been no reports of such progression, and electrophysiologic studies have not shown this phenomenon. We briefly review the interatrial conducting pathways of IAB and present the first documentation of possible progression of partial to advanced IAB.
"Partial IAB can progress to advanced IAB. Progression time from partial IAB to advanced IAB is shorter than that of the normal P-wave to advanced IAB.20 As was previously thought, advanced IAB may not exclusively be a complete block.21 "
[Show abstract][Hide abstract] ABSTRACT: Interatrial block (IAB) denotes a conduction delay between the two atria (P-wave duration ≥110 ms). Depending on the severity of the block, IAB can be partial or advanced. Even though several studies have reported a high prevalence of IAB, it still remains a diagnosis many neglect without any follow-up. The crisis in IAB is undramatic until predictable complications appear. Nevertheless, the danger in IAB is real because of the major associations with multiple medical conditions, including atrial fibrillation, myocardial ischemia, left atrial enlargement, and systemic emboli. There are different treatment options for IAB to eliminate its consequences, including pacing and medical management with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Pacing has been shown to give promising results and could potentially prevent conditions related to cardiovascular disease such as hypertension or diabetes mellitus. Given the high prevalence of IAB, together with its potentially serious consequences, and yet being largely ignored, we stress attention to this potentially dangerous pandemic and raise consideration for further investigations.
Iranian Journal of Medical Sciences 03/2014; 39(2):84-93.
[Show abstract][Hide abstract] ABSTRACT: Interatrial block (IAB; P wave > or = 110 ms) is associated with atrial tachyarrhythmias and left atrial electromechanical dysfunction. This subtle abnormality is highly prevalent and may exist as partial (pIAB) or advanced IAB (aIAB). Indeed, theoretically pIAB could progress to aIAB with worsening interatrial conduction over time. However, this has been poorly investigated. We retrospectively appraised this phenomenon and also evaluated the influence of common clinical factors such as coronary artery disease (CAD), hypertension (HTN), and use of antihypertensive medications.
Between January 2003 and June 2004, 27 patients who had aIAB on routine 12-lead ECGs were identified. Past serial ECGs of each patient were evaluated for evidence of change in IAB type. Medical records of respective patients were then reviewed for HTN, type of antihypertensive medication used, and other common comorbidities.
Median progression time from pIAB to aIAB was shorter (42 months; mean +/- SD = 39.2 +/- 30.5) compared to that of normal P wave (P-normal) to aIAB (66 months; mean +/- SD = 64.2 +/- 25.6). Use of angiotensin-converting enzyme inhibitors (ACEIs) appeared to significantly delay the progression time in patients who progressed from pIAB to aIAB (50.1 +/- 28.3 vs 10 +/- 10.4 months; P = 0.04). Beta-adrenergic blocker use alone did not significantly affect either progression time but when used in conjunction with ACEIs, appeared to slow such progression.
Progression time from pIAB to aIAB is shorter compared to that of P-normal to aIAB. Given the consequences of IAB, awareness of such progression could be important for clinicians in anticipating potential sequelae.
[Show abstract][Hide abstract] ABSTRACT: Abnormal atrial depolarization, characterized by P waves > or =110 ms on the electrocardiogram, can manifest as partial or advanced interatrial block (IAB). Advanced IAB, denoted by biphasic P waves in leads II, II and aVF, is considered to confer increased severity in interatrial conduction delay, and is now perceived to be a result of continued deterioration in interatrial impulse propagation between the atria. While progression from partial to advanced IAB has been described, the converse, resolution of advanced IAB, which has often been touted as 'complete block' to its partial, 'incomplete' type, i.e. the occurrence of intermittent advanced IAB, has escaped observations so far. We present the first known report of such a scenario.
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