Enriquez Andres, Conde Diego, Redfearn Damian P, Baranchuk Adrian
Division of Cardiology, Queen's University, Kingston, Ontario, Canada.
Cardiovascular Institute from Buenos Aires, Buenos Aires, Argentina.
Ann Noninvasive Electrocardiol. 2015 Jul;20(4):394-6. doi: 10.1111/anec.12208. Epub 2014 Sep 9.
Interatrial conduction disorders are frequent in patients with structural heart diseases, including hypertension, coronary disease, and hypertrophic cardiomyopathy, and they are strongly associated with atrial tachyarrhythmias, especially atrial fibrillation and flutter. Conduction delays lead to dispersion of refractory periods and participate in initiating and maintaining reentry circuits, facilitating atrial arrhythmias. In this case, the changing pattern over time is a manifestation of progressive atrial remodeling and conduction delay. The terminal negative component of the P wave in the inferior leads suggests block of the electrical impulse in the Bachman bundle zone, with retrograde activation of the left atria via muscular connections at the coronary sinus. This has been reproduced in experimental models and confirmed by endocardial mapping. Physicians should be aware of the association between advanced interatrial block and development of atrial arrhythmias as its recognition could prompt early and aggressive antiarrhythmic treatment.
房间传导障碍在患有结构性心脏病的患者中很常见，这些结构性心脏病包括高血压、冠心病和肥厚型心肌病，并且它们与房性快速心律失常密切相关，尤其是心房颤动和心房扑动。传导延迟会导致不应期离散，并参与折返环的启动和维持，从而促进房性心律失常。在这种情况下，随时间变化的模式是进行性心房重塑和传导延迟的表现。下壁导联P波终末负向成分提示电冲动在巴赫曼束区域阻滞，左心房通过冠状窦处的肌性连接逆向激动。这已在实验模型中得到重现，并通过心内膜标测得到证实。医生应意识到高度房间阻滞与房性心律失常发生之间的关联，因为认识到这一点可能会促使早期积极的抗心律失常治疗。
