The large sluggish LA of IAB suggests that, with the onset of AF, stasis and ultimately LA and LA appendage thrombosis are likely. This is the basis for the well-known association between untreated AF and peripheral arterial emboli, particularly cerebral emboli. Because early AF tends to be paroxysmal, such an event may be the first evidence of arrhythmia or IAB. Moreover, the risk for developing atrial arrhythmia is also substantially higher in patients with advanced IAB.6 Furthermore, the onset and offset of

paroxysmal arrhythmias are associated with a higher tendency for embolization, indicating that atrial thrombosis would have preceded them. Furthermore, p-wave analysis, including p-wave Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical dispersion, and IAB can predict AF.16 Prolonged atrial conduction is also a predisposing factor for the development of atrial flutter, where the mechanism for atrial arrhythmias is mainly due to the abnormal impulse conduction between the atria along interatrial pathways, primarily

the Bachmann’s Bundle, where atrial conduction times are increased.40-44 Interatrial Block and Left Ventricular Function With respect to LV function, IAB can give >30 ms mean delay in active (atriogenic) LV filling, associated with a considerably late activation of the LA.45 Inhibitors,research,lifescience,medical The compromised atrial “kick” from a sluggish LA and, particularly, the greatly reduced LA stroke volume and LA kinetic energy produce significantly reduced preload, additionally suggesting increased risk for congestive heart failure in patients with IAB.29 Two recent studies have Inhibitors,research,lifescience,medical demonstrated

that hemodynamic evolution of acute decompensated heart failure patients could be accessed by ECG analysis, specifically P-wave duration, although this was only seen in one case.46-48 Moreover, these studies have also shown how well P-wave morphology and duration correlate with the clinical course, development, and serum Inhibitors,research,lifescience,medical level of B-type natriuretic peptide.47,48 Interatrial Block and Ischemia IAB has been described as an additional predictive marker in detecting ischemic heart disease.49 Several studies have identified a significant relation between P-wave duration and ischemia during exercise tolerance tests.50-52 It has been shown that when a P-wave duration ≥120 milliseconds during exercise stress tests was added to the conventional criteria MTMR9 for learn more diagnosing ischemia, sensitivity would increase from 57% to 75% while specificity would drop only from 85% to 77%.51 Also, there was a greater incidence of IAB during exercise in patients with evidence of myocardial ischemia, in comparison to those without. Furthermore, the Duke Prognostic Treadmill Score, shown in a recent study, is indeed inversely associated with P-wave duration and was more significant with P-wave increases >20 milliseconds than with P-wave increases ≤20 milliseconds.52 P-wave duration or IAB is, thus, a promising factor in facilitating the diagnosis of myocardial ischemia.