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Current Cardiology Reviews

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ISSN (Print): 1573-403X
ISSN (Online): 1875-6557

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Review Article

Atrial Conduction Disorders

Author(s): Bryce Alexander, Gary Tse, Manuel Martinez-Selles and Adrian Baranchuk*

Volume 17, Issue 1, 2021

Published on: 12 January, 2021

Page: [68 - 73] Pages: 6

DOI: 10.2174/1573403X17666210112161524

Price: $65

Abstract

Atrial conduction disorders result from impaired propagation of cardiac impulses from the sinoatrial node through the atrial conduction pathways. Disorders affecting interatrial conduction alter P-wave characteristics on the surface electrocardiogram. A variety of P-wave indices reflecting derangements in atrial conduction have been described and have been associated with an increased risk of atrial fibrillation (AF) and stroke. Interatrial block (IAB) is the most well-known of the different P-wave indices and is important clinically due to its ability to predict patients who are at risk of the development of AF and other supraventricular tachycardias. P-Wave Axis is a measure of the net direction of atrial depolarization and is determined by calculating the net vector of the P-wave electrical activation in the six limb-leads using the hexaxial reference system. It has been associated with stroke and it has been proposed that this variable be added to the existing CHA2DS2-VASc score to create a P2-CHA2DS2-VASc score to improve stroke prediction. P-Terminal Force in V1 is thought to be an epiphenomenon of advanced atrial fibrotic disease and has been shown to be associated with a higher risk of death, cardiac death, and congestive heart failure as well as an increased risk of AF. P-wave Dispersion is defined as the difference between the shortest and longest P-wave duration recorded on multiple concurrent surface ECG leads on a standard 12-lead ECG and has also been associated with the development of AF and AF recurrence. Pwave voltage in lead I (PVL1) is thought to be an electrocardiographic representation of cardiac conductive properties and, therefore, the extent of atrial fibrosis relative to myocardial mass. Reduced PVL1 has been demonstrated to be associated with new-onset AF in patients with coronary artery disease and may be useful for predicting AF. Recently a risk score (the MVP risk score) has been developed using IAB and PVL1 to predict atrial fibrillation and has shown a good predictive ability to determine patients at high risk of developing atrial fibrillation. The MVP risk score is currently undergoing validation in other populations. This section reviews the different P-wave indices in-depth, reflecting atrial conduction abnormalities.

Keywords: Atrial fibrillation, interatrial block, P-wave axis, P-wave indices, atrial conduction abnormalities, Morphology-Voltage- P-Wave Duration Score.

Graphical Abstract

[1]
Antz M, Otomo K, Arruda M, et al. Electrical conduction between the right atrium and the left atrium via the musculature of the coronary sinus. Circulation 1998; 98(17): 1790-5.
[http://dx.doi.org/10.1161/01.CIR.98.17.1790] [PMID: 9788835]
[2]
Mitrofanova L, Ivanov V, Platonov PG. Anatomy of the inferior interatrial route in humans. Europace 2005; 7(Suppl. 2): 49-55.
[http://dx.doi.org/10.1016/j.eupc.2005.03.014] [PMID: 16102503]
[3]
Mirvis DM, Goldberger AL. Electrocardiography. In: Mann DL, Zipes DP, Libby P, Bonow RO (Eds)Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine (10th) Elsevier 2015 121.
[4]
Bayés de Luna A, Cladellas M, Oter R, et al. Interatrial conduction block and retrograde activation of the left atrium and paroxysmal supraventricular tachyarrhythmia. Eur Heart J 1988; 9(10): 1112-8.
[http://dx.doi.org/10.1093/oxfordjournals.eurheartj.a062407] [PMID: 3208776]
[5]
Tse G, Lai ETH, Yeo JM, Yan BP. Electrophysiological mechanisms of bayés syndrome: insights from clinical and mouse studies. Front Physiol 2016; 7: 188.
[http://dx.doi.org/10.3389/fphys.2016.00188] [PMID: 27303306]
[6]
Bayés De Luna A, Platonov P, Cosio FG, et al. Interatrial blocks. A separate entity from left atrial enlargement: A consensus report. J Electrocardiol 2012. Sep;45(5):445-51.
[http://dx.doi.org/10.1016/j.jelectrocard.2012.06.029] [PMID: 22920783]
[7]
Martínez-Sellés M. Prevalence and incidence of interatrial block in global population and in different clinical situations. J Geriatr Cardiol 2017; 14(3): 158-60.
[http://dx.doi.org/10.11909/j.issn.1671-5411.2017.03.006] [PMID: 28592956]
[8]
Ariyarajah V, Asad N, Tandar A, Spodick DH. Interatrial block: Pandemic prevalence, significance, and diagnosis. Chest 2005; 128(2): 970-5.
[http://dx.doi.org/10.1378/chest.128.2.970] [PMID: 16100193]
[9]
Waldo AL, Bush HL Jr, Gelband H, Zorn GL Jr, Vitikainen KJ, Hoffman BF. Effects on the canine P wave of discrete lesions in the specialized atrial tracts. Circ Res 1971; 29(5): 452-67.
[http://dx.doi.org/10.1161/01.RES.29.5.452] [PMID: 5120612]
[10]
Cosío FG, Martín-Peñato A, Pastor A, et al. Atrial activation mapping in sinus rhythm in the clinical electrophysiology laboratory: observations during Bachmann’s bundle block. J Cardiovasc Electrophysiol 2004; 15(5): 524-31.
[http://dx.doi.org/10.1046/j.1540-8167.2004.03403.x] [PMID: 15149420]
[11]
Guerra JM, Vilahur G, Bayés de Luna A, et al. Interatrial block can occur in the absence of left atrial enlargement: New experimental model. Pacing Clin Electrophysiol 2020; 43(4): 427-9.
[http://dx.doi.org/10.1111/pace.13895] [PMID: 32144785]
[12]
Ariyarajah V, Kranis M, Apiyasawat S, Spodick DH. Potential factors that affect electrocardiographic progression of interatrial block. Ann Noninvasive Electrocardiol 2007; 12(1): 21-6.
[http://dx.doi.org/10.1111/j.1542-474X.2007.00134.x] [PMID: 17286647]
[13]
Alexander B, MacHaalany J, Lam B, et al. Comparison of the extent of coronary artery disease in patients with versus without interatrial block and implications for new-onset atrial fibrillation. Am J Cardiol 2017; 119(8): 1162-5.
[http://dx.doi.org/10.1016/j.amjcard.2016.12.032] [PMID: 28214506]
[14]
Saremi F, Channual S, Krishnan S, Gurudevan SV, Narula J, Abolhoda A. Bachmann Bundle and its arterial supply: Imaging with multidetector CT-implications for interatrial conduction abnormalities and arrhythmias. Radiology 2008; 248(2): 447-57.
[http://dx.doi.org/10.1148/radiol.2482071908] [PMID: 18641248]
[15]
Benito EM, De Luna AB, Baranchuk A, Mont L. Extensive atrial fibrosis assessed by late gadolinium enhancement cardiovascular magnetic resonance associated with advanced interatrial block electrocardiogram pattern. Europace 2017; 19(3): 377.
[http://dx.doi.org/10.1093/europace/euw294] [PMID: 28395012]
[16]
Benito EM, Carlosena-Remirez A, Guasch E, et al. Left atrial fibrosis quantification by late gadolinium-enhanced magnetic resonance: A new method to standardize the thresholds for reproducibility. EP Eur 2016; 1-8.
[17]
Alexander B, Baranchuk A. Progressive Interatrial Block. interatrial block and supraventricular arrhythmias: clinical implications of bayés syndrome. 1st ed. Cardiotext Publishing 2017; pp. 161-70.
[18]
Alexander B, Sadiq F, Azimi K, et al. Reverse atrial electrical remodeling induced by cardiac resynchronization therapy. J Electrocardiol 2017; 50(5): 610-4.
[http://dx.doi.org/10.1016/j.jelectrocard.2017.04.015] [PMID: 28515003]
[19]
Bayés de Luna A, Platonov P, Cosio FG, et al. Interatrial blocks. A separate entity from left atrial enlargement: A consensus report. J Electrocardiol 2012; 45(5): 445-51.
[http://dx.doi.org/10.1016/j.jelectrocard.2012.06.029] [PMID: 22920783]
[20]
de Luna AB, Platonov PG, García-Niebla J, Baranchuk A. Atypical advanced interatrial block or junctional rhythm? J Electrocardiol 2019; 54: 85-6.
[http://dx.doi.org/10.1016/j.jelectrocard.2019.03.014] [PMID: 30953789]
[21]
Tse G, Wong CW, Gong M, et al. International Health Informatics Study (IHIS) Network. Predictive value of inter-atrial block for new onset or recurrent atrial fibrillation: A systematic review and meta-analysis. Int J Cardiol 2018; 250: 152-6.
[http://dx.doi.org/10.1016/j.ijcard.2017.09.176] [PMID: 29017777]
[22]
Martínez-Sellés M, Baranchuk A, Elosua R, de Luna AB. Rationale and design of the BAYES (Interatrial Block and Yearly Events) registry. Clin Cardiol 2017; 40(4): 196-9.
[http://dx.doi.org/10.1002/clc.22647] [PMID: 27883210]
[23]
Maheshwari A, Norby FL, Soliman EZ, et al. Refining prediction of atrial fibrillation risk in the general population with analysis of p-wave axis (from the atherosclerosis risk in communities study). Am J Cardiol 2017; 120(11): 1980-4.
[http://dx.doi.org/10.1016/j.amjcard.2017.08.015] [PMID: 28941601]
[24]
Maheshwari A, Norby FL, Soliman EZ, et al. Abnormal p-wave axis and ischemic stroke: the aric study (atherosclerosis risk in communities). Stroke 2017; 48(8): 2060-5.
[http://dx.doi.org/10.1161/STROKEAHA.117.017226] [PMID: 28626057]
[25]
Maheshwari A, Norby FL, Roetker NS, et al. Refining prediction of atrial fibrillation-related stroke using the P2-CHA2DS2-VASc Score. Circulation 2019; 139(2): 180-91.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.118.035411] [PMID: 30586710]
[26]
Morris JJ, Estes EH, Whalen RE, Thompson HK, Mcintosh HD. P-Wave analysis in valvular heart disease. Circulation 1964; 29: 242-52.
[http://dx.doi.org/10.1161/01.CIR.29.2.242]
[27]
Eranti A, Aro AL, Kerola T, et al. Prevalence and prognostic significance of abnormal P terminal force in lead V1 of the ECG in the general population. Circ Arrhythm Electrophysiol 2014; 7(6): 1116-21.
[http://dx.doi.org/10.1161/CIRCEP.114.001557] [PMID: 25381332]
[28]
Tereshchenko LG, Henrikson CA, Sotoodehnia N, et al. Electrocardiographic deep terminal negativity of the P wave in V(1) and risk of sudden cardiac death: The Atherosclerosis Risk in Communities (ARIC) study. J Am Heart Assoc 2014; 3(6): e001387.
[http://dx.doi.org/10.1161/JAHA.114.001387] [PMID: 25416036]
[29]
Hazen MS, Marwick TH, Underwood DA. Diagnostic accuracy of the resting electrocardiogram in detection and estimation of left atrial enlargement: An echocardiographic correlation in 551 patients. Am Heart J 1991; 122(3 Pt 1): 823-8.
[http://dx.doi.org/10.1016/0002-8703(91)90531-L] [PMID: 1831587]
[30]
He J, Tse G, Korantzopoulos P, et al. P-wave indices and risk of ischemic stroke: A systematic review and meta-analysis. Stroke 2017; 48(8): 2066-72.
[http://dx.doi.org/10.1161/STROKEAHA.117.017293] [PMID: 28679858]
[31]
Okutucu S, Aytemir K, Oto A. P-wave dispersion: What we know till now? JRSM Cardiovasc Dis 2016; 5: 2048004016639443.
[http://dx.doi.org/10.1177/2048004016639443] [PMID: 27081484]
[32]
Benito EM, De Luna AB, Baranchuk A, Mont L. Extensive atrial fibrosis assessed by late gadolinium enhancement cardiovascular magnetic resonance associated with advanced interatrial block electrocardiogram pattern. Europace 2017; 19(3): 377-7.
[http://dx.doi.org/10.1093/europace/euw294] [PMID: 28395012]
[33]
Park J, Park J, Uhm J, Joung B, Lee M, Pak H. Low P-wave amplitude ( < 0.1 mV ) in lead I is associated with displaced inter-atrial conduction and clinical recurrence of paroxysmal atrial fibrillation after radiofrequency catheter ablation. Europace 2016; 384-91.
[34]
Alexander B, Milden J, Hazim B, et al. New electrocardiographic score for the prediction of atrial fibrillation: The MVP ECG risk score (morphology-voltage-P-wave duration). Ann Noninvasive Electrocardiol 2019; 24(6): e12669.
[http://dx.doi.org/10.1111/anec.12669] [PMID: 31184409]
[35]
Cohen A, Ederhy S, Di Angelantonio E. Mechanisms of thrombogenesis in atrial fibrillation. Lancet 2009; 373(9668): 1005-6.
[http://dx.doi.org/10.1016/S0140-6736(09)60603-6] [PMID: 19304009]
[36]
Martin DT, Bersohn MM, Waldo AL, et al. IMPACT Investigators. Randomized trial of atrial arrhythmia monitoring to guide anticoagulation in patients with implanted defibrillator and cardiac resynchronization devices. Eur Heart J 2015; 36(26): 1660-8.
[http://dx.doi.org/10.1093/eurheartj/ehv115] [PMID: 25908774]
[37]
Brambatti M, Connolly SJ, Gold MR, et al. ASSERT Investigators. Temporal relationship between subclinical atrial fibrillation and embolic events. Circulation 2014; 129(21): 2094-9.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.113.007825] [PMID: 24633881]
[38]
Goette A, Kalman JM, Aguinaga L, et al. Document Reviewers. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: Definition, characterization, and clinical implication. Europace 2016; 18(10): 1455-90.
[http://dx.doi.org/10.1093/europace/euw161] [PMID: 27402624]
[39]
Goldberger JJ, Arora R, Green D, et al. Evaluating the atrial myopathy underlying atrial fibrillation: Identifying the arrhythmogenic and thrombogenic substrate. Circulation 2015; 132(4): 278-91.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.115.016795] [PMID: 26216085]
[40]
Kamel H, Longstreth WT Jr, Tirschwell DL, et al. The Atrial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke randomized trial: Rationale and methods. Int J Stroke 2019; 14(2): 207-14.
[http://dx.doi.org/10.1177/1747493018799981] [PMID: 30196789]

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