Cardiovascular Complications of Interatrial Conduction Block: JACC State-of-the-Art Review

doi:10.1016/j.jacc.2022.01.030

Journal of the American College of Cardiology

Volume 79, Issue 12, 29 March 2022, Pages 1199-1211

https://doi.org/10.1016/j.jacc.2022.01.030 Get rights and content

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Highlights

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Interatrial block can be classified as partial (P-wave duration ≥120 ms), intermittent (appearing and disappearing within a short period of time), or advanced (P-wave duration ≥120 ms with biphasic P-wave morphology in the inferior leads).
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Interatrial block is common, increases with age, and is associated with ischemic heart disease, hypertension, and sleep apnea.
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Advanced interatrial block, in particular, is a risk factor for development of atrial fibrillation, ischemic stroke during sinus rhythm, cognitive impairment, and death.

Abstract

Interatrial block (IAB) is an electrocardiographic pattern describing the conduction delay between the right and left atria. IAB is classified into 3 degrees of block that correspond to decreasing conduction in the region of Bachmann’s bundle. Although initially considered benign in nature, specific subsets of IAB have been associated with atrial arrhythmias, elevated thromboembolic stroke risk, cognitive impairment, and mortality. As the pathophysiologic relationships between IAB and stroke are reinforced, investigation has now turned to the potential benefit of early detection, atrial imaging, cardiovascular risk factor modification, antiarrhythmic pharmacotherapy, and stroke prevention with oral anticoagulation. This review provides a contemporary overview of the epidemiology, pathophysiology, diagnosis, and management of IAB, with a focus on future directions.

Central Illustration

Key Words

anticoagulation

atrial fibrillation

IAB

interatrial block

state-of-the-art review

Abbreviations and Acronyms

atrial fibrillation

A-IAB

advanced interatrial block

atrioventricular

Bachmann’s bundle

C-MRI

cardiac magnetic resonance imaging

CPAP

continuous positive airway pressure

ESUS

embolic stroke of undetermined source

FAC

fibrotic atrial cardiomyopathy

IAB

interatrial block

left atrial

LAE

left atrial enlargement

OAC

oral anticoagulation

OSA

obstructive sleep apnea

P-IAB

partial interatrial block

TAVR

transcatheter aortic valve replacement

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: Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.

: Jagmeet Singh, MD, PhD, served as Guest Associate Editor for this paper. Javed Butler, MD, PhD, served as the Guest Editor-in-Chief for this paper.

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