Tekkesin Ahmet Ilker, Çinier Göksel, Cakilli Yasin, Hayıroğlu Mert İlker, Alper Ahmet Taha
Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Center, Istanbul.
Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Center, Istanbul.
J Electrocardiol. 2017 Mar-Apr;50(2):234-237. doi: 10.1016/j.jelectrocard.2016.09.004. Epub 2016 Sep 8.
Interatrial block which is defined as P wave duration longer than 120 milliseconds is underappreciated but highly prevalent electrocardiographic abnormality and associated with atrial tachyarrhythmias and ischemic stroke. Impaired left atrial mechanics and atrial fibrillation are potential mechanisms contributing to the embolic events associated with interatrial block. Detection of atrial high rate episodes by cardiac implantable electronic devices provides clinicians to diagnose asymptomatic atrial fibrillation. The relation between interatrial block and asymptomatic atrial fibrillation can provide an insight to the increased risk of ischemic stroke in patients with interatrial block.
We prospectively evaluated 367 patients who were implanted dual chamber pacemaker due to sinus node dysfunction (SND) between January 2015 and December 2015. Twelve lead electrocardiograms were analyzed to diagnose interatrial block before pacemaker implantation. Six months after the implantation, pacemakers were interrogated to detect atrial high rate episodes. Patients were divided into two groups in terms of presence or absence of atrial high rate episodes.
Atrial high rate episodes were detected in 107 (30.1%) patients during their device interrogation. Interatrial block was found in 115 (32.4%) patients out of total study population. Sixty-seven (27.0%) patients in AHRE (-) group had interatrial block while 48 (44.9%) patients had in AHRE (+) group. Prevalence of interatrial block was statistically significantly higher in AHRE (+) patients (P<0.01).
Occurrence of atrial high rate episodes, a surrogate for asymptomatic atrial fibrillation, is statistically significantly higher in patients with interatrial block.
心房传导阻滞被定义为P波时限超过120毫秒，是一种未得到充分认识但非常普遍的心电图异常，与房性快速性心律失常和缺血性卒中相关。左心房机械功能受损和心房颤动是导致与心房传导阻滞相关的栓塞事件的潜在机制。心脏植入式电子设备检测到心房高频率事件可为临床医生诊断无症状心房颤动提供依据。心房传导阻滞与无症状心房颤动之间的关系有助于深入了解心房传导阻滞患者缺血性卒中风险增加的原因。
我们前瞻性评估了2015年1月至2015年12月期间因窦房结功能障碍（SND）植入双腔起搏器的367例患者。在起搏器植入前分析12导联心电图以诊断心房传导阻滞。植入后6个月，对起搏器进行问询以检测心房高频率事件。根据是否存在心房高频率事件将患者分为两组。
在设备问询期间，107例（30.1%）患者检测到心房高频率事件。在全部研究人群中，115例（32.4%）患者存在心房传导阻滞。在无心房高频率事件（AHRE）（-）组中，67例（27.0%）患者存在心房传导阻滞，而在有AHRE（+）组中，48例（44.9%）患者存在心房传导阻滞。AHRE（+）组患者心房传导阻滞的患病率在统计学上显著更高（P<0.01）。
心房传导阻滞患者中，作为无症状心房颤动替代指标的心房高频率事件的发生率在统计学上显著更高。
