Intermittent interatrial block after electrical cardioversion for atrial fibrillation
Section snippets
Case report
A 67-year-old woman with persistent atrial fibrillation (AF) presented for elective electrical cardioversion. Atrial fibrillation had been detected several months previously, and the patient had been optimally anticoagulated for 8 weeks before the procedure. The patient was treated with metoprolol 50 mg twice a day.
Transthoracic 2-dimensional echocardiogram revealed global left ventricular hypokinesis with an ejection fraction of 40%, normal right ventricular size, and mild tricuspid
Discussion
Interatrial block is caused by conduction delay between the right and left atria (P-wave duration >110 milliseconds) and has been found to be associated with development of atrial tachyarrhythmia.1 It is also associated with left atrial enlargement, and it could represent a risk factor for systemic thromboembolic events due to poorly contracting left atria.2 Intermittent interatrial block is caused by abnormal conduction over Bachmann's bundle, resulting in a delay of left atrial depolarization.
Conclusion
Intermittent interatrial block after electrical cardioversion of atrial fibrillation has not been previously described. It is an interesting finding that may represent an abnormal sequence of activation of the left atrium. The observation of intermittent IAB in this postcardioversion patient invites speculation about the mechanisms of reverse electrical remodeling in the just-cardioverted patient with AF, as well as the potential role of IAB in early recurrences of AF. Presence of IAB should be
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Cited by (8)
Advanced interatrial block is an electrocardiographic marker for recurrence of atrial fibrillation after electrical cardioversion
2018, International Journal of CardiologyCitation Excerpt :This aIAB is also associated with a higher risk of AF recurrence at 1 year after pharmacological cardioversion [12]. In a case report, the presence of intermittent IAB after ECV of AF could be a predictor of early AF recurrence. [13] To date, aIAB has been found to exist in various conditions such as in older people, a male gender, the white race, dyslipidemia, a higher body mass index, and hypertension [14].
Second-degree interatrial block: A case series
2019, Journal of ElectrocardiologyCitation Excerpt :It was unknown if AF was present in two patients as outpatient investigations were loss to follow-up. Second degree or intermittent interatrial block is an ECG pattern that has only briefly been described in literature [3–5]. In the largest case series to date, we describe eight cases of second degree IAB.
Bayés syndrome
2017, Revista Colombiana de CardiologiaInteratrial block as anatomical-electrical substrate for supraventricular arrhythmias: Bayes' syndrome
2014, Archivos de Cardiologia de MexicoInteratrial block in ECG after immediate electrical cardioversion as a predictor of recurrence of atrial fibrillation
2019, Revista de la Federacion Argentina de CardiologiaUpdate on Bayés’ syndrome: the association between an interatrial block and supraventricular arrhythmias
2019, Expert Review of Cardiovascular Therapy