Relation of Advanced Interatrial Block to Risk of Atrial Fibrillation and Stroke
Por:
Bayes-de-Luna, A, Martinez-Selles, M, Elosua, R, Bayes-Genis, A, Mendieta, G, Baranchuk, A and Breithardt, G
Publicada:
1 jun 2020
Ahead of Print:
16 mar 2020
Resumen:
Advanced interatrial block (A-IAB) has been associated to atrial fibrillation (AF) and ischemic stroke, raising the question as to whether such patients, even when still in sinus rhythm without documented AF, could benefit from oral anticoagulation. AF and A-IAB are both markers of stroke. The anatomical substrate in both is fibrotic atrial cardiomyopathy, resulting in atrial electromechanical dyssynchrony, dysfunction, and left atrial remodelling, that favour blood stasis and hypercoagulation. Under these conditions thrombogenic cascade may be triggered, resulting in systemic embolization. Before proposing oral anticoagulation in the management of selected patients with A-IAB, as is currently recommended in patients with AF and high CHA(2)DS(2)-Vasc score, a randomized clinical trial will have to demonstrate efficacy and safety of anticoagulation in this setting. In the meantime, an individualized approach may be considered based on the recognition of those patients at a higher risk of stroke. These may be elderly patients with A-IAB and several risk factors and, thus, with a high CHA(2)DS(2)-Vasc score and the presence of environmental arrhythmias. (C) 2020 Elsevier Inc. All rights reserved.
Filiaciones:
Bayes-de-Luna, A:
IIB St Pau, Cardiovasc Res Fdn, Res Inst Hosp Santa Creu & St Pau, Cardiovasc ICCC Program, Barcelona, Spain
Martinez-Selles, M:
Univ Complutense, Hosp Univ Gregorio Maranon, Dept Cardiol, CIBERCV,Univ Europea, Madrid, Spain
Elosua, R:
Hosp del Mar Med Res Inst IMIM, Cardiovasc Epidemiol & Genet Res Grp, REGICOR Grp, Barcelona, Catalonia, Spain
CIBER Cardiovasc, Barcelona, Catalonia, Spain
Univ Vic, Cent Univ Catalonia UVic UCC, Med Dept, Med Sch, Vic, Catalonia, Spain
:
Hosp Badalona Germans Trias & Pujol, Heart Inst, Barcelona, Spain
Autonomous Univ Barcelona, Dept Med, CIBERCV, Barcelona, Spain
Mendieta, G:
Hosp Clin Barcelona, Cardiovasc Inst, Cardiol, Barcelona, Spain
Baranchuk, A:
Kingston Hlth Sci Ctr, Div Cardiol, Kingston, ON, Canada
Breithardt, G:
Univ Hosp Munster, Dept Cardiovasc Med, Div Rhythmol, Munster, Germany
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