Ariyarajah Vignendra, Apiyasawat Sirin, Najjar Husam, Mercado Kristin, Puri Puneet, Spodick David H
Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Boston, MA, USA.
Am J Cardiol. 2007 Jan 1;99(1):49-52. doi: 10.1016/j.amjcard.2006.07.060. Epub 2006 Nov 3.
Interatrial block (IAB; P wave > or =110 ms) is a potent correlate of left atrial (LA) enlargement and electromechanical dysfunction and a strong predictor of atrial tachyarrhythmias, in particular, atrial fibrillation. Although these associations increase its risk for embolism, i.e., cardioembolic stroke, such a phenomenon has been inadequately investigated. We investigated 85 general hospital patients who had been admitted to the neurologic unit between January 2003 and December 2004 for embolic stroke. Of those, 66 patients who had electrocardiograms that showed sinus rhythm were evaluated for IAB and categorized as those with IAB and those without (controls). Medical records were then reviewed for common co-morbidities and stroke risk factors, high-resolution carotid artery Doppler ultrasonographic study reports, and 2-dimensional echocardiograms obtained during the current admission for embolic stroke; 40 patients (61%) had IAB. There was a 55% prevalence of LA enlargement (diameter in the parasternal long-axis view > or =40 mm, p <0.001). LA thrombi and/or spontaneous contrast ("smoke") were noted on echocardiograms in 6 patients with IAB (15%) but not in any of the controls (p = 0.038). Five of those 6 patients with such LA thrombi had dilated LA cavities. In conclusion, IAB could be a risk for embolic stroke due to its known sequelae of LA dilation and electromechanical dysfunction that predispose to thrombosis. If prospective studies prove this to be so, the need for anticoagulation use in such patients should be investigated.
房间阻滞（IAB；P波≥110毫秒）与左心房（LA）扩大及机电功能障碍密切相关，是房性快速心律失常尤其是房颤的有力预测指标。尽管这些关联增加了其发生栓塞（即心源性栓塞性卒中）的风险，但对此现象的研究尚不充分。我们调查了2003年1月至2004年12月间因栓塞性卒中入住神经科的85例综合医院患者。其中，对66例心电图显示窦性心律的患者进行了房间阻滞评估，并分为有房间阻滞组和无房间阻滞组（对照组）。然后查阅病历以了解常见的合并症和卒中危险因素、高分辨率颈动脉多普勒超声研究报告以及本次因栓塞性卒中入院时获得的二维超声心动图；40例患者（61%）存在房间阻滞。左心房扩大的患病率为55%（胸骨旁长轴切面直径≥40毫米，p<0.001）。6例有房间阻滞的患者（15%）在超声心动图上发现左心房血栓和/或自发显影（“烟雾”），而对照组中无一例出现（p = 0.038）。这6例有左心房血栓的患者中有5例左心房腔扩大。总之，由于房间阻滞已知的后遗症是左心房扩张和机电功能障碍，易导致血栓形成，因此可能是栓塞性卒中的一个危险因素。如果前瞻性研究证实确实如此，则应研究此类患者使用抗凝治疗的必要性。
