Ariyarajah Vignendra, Kranis Mark, Apiyasawat Sirin, Spodick David H
Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Boston, MA, USA.
Ann Noninvasive Electrocardiol. 2007 Jan;12(1):21-6. doi: 10.1111/j.1542-474X.2007.00134.x.
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.
房间阻滞（IAB；P波≥110毫秒）与房性快速心律失常及左心房机电功能障碍相关。这种细微异常非常普遍，可能以部分性（pIAB）或进展性IAB（aIAB）形式存在。实际上，从理论上讲，随着时间推移房间传导恶化，pIAB可能进展为aIAB。然而，这方面的研究很少。我们回顾性评估了这一现象，并评估了冠状动脉疾病（CAD）、高血压（HTN）及使用抗高血压药物等常见临床因素的影响。
在2003年1月至2004年6月期间，确定了27例在常规12导联心电图上存在aIAB的患者。评估每位患者过去的系列心电图，以寻找IAB类型变化的证据。然后查阅各患者的病历，了解高血压情况、所用抗高血压药物类型及其他常见合并症。
与正常P波（P-正常）进展为aIAB的时间（66个月；平均±标准差=64.2±25.6）相比，从pIAB进展为aIAB的中位时间较短（42个月；平均±标准差=39.2±30.5）。使用血管紧张素转换酶抑制剂（ACEI）似乎能显著延迟从pIAB进展为aIAB的患者的进展时间（50.1±28.3对10±10.4个月；P=0.04）。单独使用β-肾上腺素能阻滞剂对进展时间均无显著影响，但与ACEI联合使用时，似乎能减缓这种进展。
与P-正常进展为aIAB相比，从pIAB进展为aIAB的时间更短。鉴于IAB的后果，了解这种进展情况对临床医生预测潜在后遗症可能很重要。
