Di Chengye, Wang Haijiang, Wang Mingming, Wang Qun, Wu Yanxi, Li Longyu, Zhang Yan, Lin Wenhua
Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital, 3rd Street, Tianjin Economic-Technological Development Area, 300457, Tianjin, China.
College of Clinical Cardiology, Tianjin Medical University, Tianjin, China.
Herz. 2025 Apr;50(2):122-134. doi: 10.1007/s00059-024-05272-z. Epub 2024 Sep 24.
Electrocardiograms (ECGs) and angiographic features indicative of acute atrial infarction (AAI) often go unnoticed and are under-recognized in clinical practice.
In this retrospective observational study, we analyzed the data of 3981 out of 9803 patients (40.61%) who were referred to our hospital for angiography and/or percutaneous coronary intervention due to acute coronary syndrome (ACS). These patients were diagnosed with acute ST segment elevation myocardial infarction (AMI) affecting the inferior, posterior, and/or right ventricular regions.
Of the 3981 patients, 270 (6.78%) had involvement of the main coronary atrial branch meeting the angiographic criteria for AAI. Among the 270 patients identified, the right coronary artery was diagnosed as the infarct-related artery (IRA) in 187 patients (group R), while the left circumflex artery was the IRA in 83 patients (group L). The incidence of PR-segment deviation was similar between the two groups (65.2% in group R vs. 66.3% in group L, p = 0.870), as was occurrence of atrial tachyarrhythmia (67.4% vs. 55.4%, p = 0.059). The prevalence of P wave morphology abnormalities (29.9% vs. 49.4%, p = 0.005) and sinus bradycardia or arrest (25.1% vs. 66.3%, p < 0.001) was significantly lower in Group R than in Group L.
Acute atrial infarction represents a distinct yet frequently overlooked clinical entity. Clinicians should consider the potential for atrial arrhythmias, thromboembolism, hemodynamic instability, and atrial rupture when diagnosing AAI.
提示急性心房梗死（AAI）的心电图（ECG）和血管造影特征在临床实践中常被忽视且未得到充分认识。
在这项回顾性观察研究中，我们分析了9803例因急性冠状动脉综合征（ACS）转诊至我院进行血管造影和/或经皮冠状动脉介入治疗的患者中的3981例（40.61%）的数据。这些患者被诊断为影响下壁、后壁和/或右心室区域的急性ST段抬高型心肌梗死（AMI）。
在3981例患者中，270例（6.78%）主冠状动脉心房支受累，符合AAI的血管造影标准。在确诊的270例患者中，右冠状动脉被诊断为梗死相关动脉（IRA）的有187例（R组），而左旋支动脉为IRA的有83例（L组）。两组PR段偏移的发生率相似（R组为65.2%，L组为66.3%，p = 0.870），房性快速心律失常的发生率也相似（67.4%对55.4%，p = 0.059）。R组P波形态异常（29.9%对49.4%，p = 0.005）和窦性心动过缓或停搏（25.1%对66.3%，p < 0.001）的发生率显著低于L组。
急性心房梗死是一种独特但常被忽视的临床实体。临床医生在诊断AAI时应考虑房性心律失常、血栓栓塞、血流动力学不稳定和心房破裂的可能性。
