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      Progression of Advanced Interatrial Block to Atrial Flutter: A Prospectively-Followed Case

      a, b , c

      Cardiology

      S. Karger AG

      Interatrial block, Atrial flutter, Progression, Electrocardiogram

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          Abstract

          Interatrial block (IAB; P wave ≧110 ms), commonly associated with left atrial enlargement and its electromechanical dysfunction, is also a significant correlate of atrial tachyarrhythmias. While the arrhythmogenic mechanisms of atrial fibrillation and atrial flutter may indeed differ, there is actually considerably less literature showing evidence of prospective progression of IAB, be it partial or advanced, to atrial flutter. We present a unique case of atrial flutter occurring within months of diagnosis of advanced IAB in an otherwise healthy female to briefly generate our discussion on the possible reasons for this scenario.

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          Most cited references 3

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          Correlation of left atrial size with p-wave duration in interatrial block.

          Interatrial block (IAB) [P-wave duration > or = 110 ms] is associated with left atrial (LA) enlargement (LAE) and pathophysiologic derangements that result in atrial tachyarrhythmias, LA electromechanical dysfunction, and embolism. However, there has been no study addressing the direct correlation of P-wave duration in IAB and LAE. One hundred eighty-one consecutive patients who were admitted to a tertiary care teaching hospital over 5 consecutive days were screened for past transthoracic echocardiogram evaluations and were then matched with ECGs done within 10 days of these echocardiographic investigations. ECGs were evaluated for presence of IAB, and patients were subsequently classified into two groups: control patients and patients with IAB. Patients were also matched for common comorbidities. Mean, SD of age, Pearson correlation coefficient (r), p values, and multivariate and linear regression analyses were analyzed for the investigated variables of LA size, left ventricular hypertrophy (LVH), posterior wall thickness, septal thickness, and P-wave duration. From the sample (n = 66; mean age +/- SD, 71.3 +/- 13.7; female gender, 48.5%), the mean LA size in the control group was 36.7 +/- 4.01 mm and for the group of patients with IAB (n = 38) was 42.2 +/- 7.25 mm (p = 0.004). Linear regression analysis revealed that P-wave duration was significantly correlated with LA size (p = 0.0002, r = 0.606). Degree of conduction delay in IAB (P-wave duration) is an independent, direct correlate of LAE, and the regression equation (LA size [in millimeters] = 2.47 +/- 0.29 x P-wave duration [in milliseconds]) could be used to estimate LAE.
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            Interatrial block as a predictor of embolic stroke.

            Interatrial block (IAB), defined as a prolonged (>/=110 ms) P wave, is remarkably prevalent in general hospital populations and is associated with an enlarged, poorly contractile left atrium. The investigators sought to determine whether there is an increased incidence of IAB in patients with embolic strokes. Patients' medical records were reviewed for evidence of embolic cerebrovascular events and IAB. One hundred four patients were identified. In 61 patients in normal sinus rhythm, 49 (80%) had IAB. This was almost twice the prevalence of 2 previous studies (41% and 47%). Therefore, IAB may represent a new risk factor for stroke.
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              • Article: not found

              Interatrial block: pandemic prevalence, significance, and diagnosis.

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                Author and article information

                Journal
                CRD
                Cardiology
                10.1159/issn.0008-6312
                Cardiology
                S. Karger AG
                0008-6312
                1421-9751
                2006
                September 2006
                29 September 2006
                : 106
                : 3
                : 161-163
                Affiliations
                aMassachusetts Veterans Epidemiology Research and Information Center (MAVERIC), bVeterans Affairs Boston Healthcare System, and Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass., and cDepartment of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Mass., USA
                Article
                92771 Cardiology 2006;106:161–163
                10.1159/000092771
                16636546
                © 2006 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 1, References: 5, Pages: 3
                Categories
                Case Report

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