Bayés Syndrome
2018; Lippincott Williams & Wilkins; Volume: 137; Issue: 2 Linguagem: Francês
10.1161/circulationaha.117.032333
ISSN1524-4539
AutoresAdrián Baranchuk, P. Torner, Antoni Bayés de Luna,
Tópico(s)ECG Monitoring and Analysis
ResumoHomeCirculationVol. 137, No. 2Bayés Syndrome Free AccessCase ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCase ReportPDF/EPUBBayés SyndromeWhat Is It? Adrian Baranchuk, MD, Pelayo Torner, MD and Antoni Bayés de Luna, MD, PhD Adrian BaranchukAdrian Baranchuk Heart Rhythm Service, Kingston Hospital, Ontario, Canada (A.B.) , Pelayo TornerPelayo Torner Department of Electrophysiology and Arrhythmias, St. Pau Hospital, Barcelona, Spain (P.T.) and Antoni Bayés de LunaAntoni Bayés de Luna Autonomous University of Barcelona, Institut Català Ciències Cardiovasculars–St. Pau Hospital, and Quiron Barcelona Hospital, Spain (A.B.d.L.). Originally published9 Jan 2018https://doi.org/10.1161/CIRCULATIONAHA.117.032333Circulation. 2018;137:200–202ECG ChallengeThe patient is a 76-year-old woman with history of arterial hypertension treated with angiotensin-converting enzyme inhibitors and calcium antagonists. She complained about palpitations, usually of short duration, more frequently during the night. The 12-lead ECG is shown in Figure 1. What is the electrocardiographic diagnosis?Download figureDownload PowerPointFigure 1. Typical example of advanced interatrial block with P ± in leads II, III, and VF and a duration >120 milliseconds. When the P wave is amplified, we can see much better the beginning and end of P waves in the 3 leads.Please turn the page to read the diagnosis.Response to ECG ChallengeThis 12-lead ECG shows sinus rhythm with first-degree atrioventricular block (PR=250 milliseconds) and with low-voltage R-wave complexes in leads I, aVL, and V6 without q waves that may be explained by partial left bundle-branch block. The presence of a small r wave in lead V1 may be caused by depolarization of the right ventricular wall. The echocardiogram confirmed normal left ventricular wall thickness.The major abnormality of this 12-lead ECG is the P wave. Calipers and magnification of the ECG are needed to assess the duration and voltage of the P wave properly. The duration of the P wave is very long (185 milliseconds) and in the inferior leads (II, III, and aVF) depicts biphasic (±) morphology. These changes represent the current definition criteria of advanced interatrial block (A-IAB).1 The duration of the P wave must be measured in the frontal plane leads from the earliest detection of the P wave in any lead (onset) to the last one (offset) (Figure 1).Figure 2 depicts the atrial activation in normal circumstances (Figure 2A) and in the case of partial block (Figure 2B) and A-IAB (Figure 2C).1 In the last, the stimulus is completely blocked in the Bachmann region, and activation of the left atrium (LA) occurs retrogradely through a zone located close to the coronary sinus. This explains the final negative component of the P wave in the inferior leads.Download figureDownload PowerPointFigure 2. Diagram of atrial activation.A, Normal circumstances, (B) partial interatrial block, and (C) advanced interatrial block (see text). P wave in VF indicates P in VF lead; and P loop in FP, P loop in frontal plane.Atrial fibrosis is considered the anatomic substrate of A-IAB, which does not necessarily mean that the LA is enlarged. In fact, in this case, the LA measured by echocardiogram was only 37 mm, and the P-terminal force in lead V1 is normal (Morris index 140 milliseconds, can develop atrial fibrillation (AF) and atrial flutter in a short-term follow-up. In this case, Holter monitoring presents frequent runs of AF. One of them was captured in a 12-lead ECG (Figure 3). The association of a-IAB and AF has been called Bayés syndrome.2,3Download figureDownload PowerPointFigure 3. The patient presented with frequent crises of paroxysmal atrial fibrillation that even may be recorded in a surface ECG.Recent studies showed that A-IAB was associated with AF/atrial flutter and even with stroke in many different clinical scenarios, including a large cohort of the general population.2 The association with stroke, without documented AF, could open the door to the hypothesis of early anticoagulation. More definitive answers in this regard will be provided by prospective registries and ongoing randomized trials involving this population.In summary, we presented a case that shows that careful evaluation of the surface P wave may result in valuable clinical information to predict the risk of AF and stroke.DisclosuresNone.FootnotesCirculation is available at http://circ.ahajournals.org.Correspondence to: Antonio Bayés de Luna, MD, PhD, C/ Sant Antoni Mª Claret, 167, 08025 Barcelona, Spain. E-mail [email protected]References1. Bayés de Luna A, Platonov P, García-Cosio F, Cygankiewicz I, Pastore C, Baranowski R, Bayés-Genís A, Guindo J, Viñolas X, García-Niebla J, Barbosa R, Stern S, Spodick D. Interatrial blocks: a separate entity from left atrial enlargement: a consensus report.J Electrocardiol. 2012; 45:445–451.CrossrefMedlineGoogle Scholar2. Baranchuk A. Interatrial Block and Supraventricular Arrhythmias: Clinical Implications of Bayés' Syndrome. Minneapolis, MN: Cardiotext Publishing; 2017.Google Scholar3. Bacharova L, Wagner GS. The time for naming the interatrial block syndrome: Bayes syndrome.J Electrocardiol. 2015; 48:133–134. doi: 10.1016/j.jelectrocard.2014.12.022.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Mahendiran T and Pascale P (2022) Narrow complex tachycardia with discordant 12-lead RP intervals, Journal of Electrocardiology, 10.1016/j.jelectrocard.2022.03.004, 72, (79-81), Online publication date: 1-May-2022. Power D, Lampert J, Camaj A, Bienstock S, Kocovic N, Bayes-Genis A, Miller M, Bayés-de-Luna A and Fuster V (2022) Cardiovascular Complications of Interatrial Conduction Block, Journal of the American College of Cardiology, 10.1016/j.jacc.2022.01.030, 79:12, (1199-1211), Online publication date: 1-Mar-2022. Gentille‐Lorente D, Scott L, Escobar‐Robledo L, Mesa‐Maya M, Carreras‐Costa F, Baranchuk A, Martínez‐Sellés M, Elosua R, Bayés‐Genís A and Bayés‐de‐Luna A (2021) Atypical advanced interatrial block due to giant atrial lipoma, Pacing and Clinical Electrophysiology, 10.1111/pace.14210, 44:4, (737-739), Online publication date: 1-Apr-2021. Kohli U, Chaudhuri N, Sriram C and Rhodes L (2021) Temporal progression of P wave abnormality in a patient with classical or atriopulmonary Fontan, Journal of Electrocardiology, 10.1016/j.jelectrocard.2021.08.008, 68, (109-113), Online publication date: 1-Sep-2021. Carmona Puerta R (2020) Bloqueos interauriculares: diagnóstico y significado clínico, Medicina Clínica, 10.1016/j.medcli.2020.03.011, 155:5, (207-214), Online publication date: 1-Sep-2020. Fujimoto Y, Yodogawa K, Oka E, Hayashi H, Yamamoto T, Murata H, Iwasaki Y, Hayashi M and Shimizu W (2020) Significance of fragmented QRS complexes for predicting new-onset atrial fibrillation after cavotricuspid isthmus–dependent atrial flutter ablation, Heart Rhythm, 10.1016/j.hrthm.2020.04.021, 17:9, (1493-1499), Online publication date: 1-Sep-2020. Ciuffo L, Bruña V, Martínez‐Sellés M, Vasconcellos H, Tao S, Zghaib T, Nazarian S, Spragg D, Marine J, Berger R, Lima J, Calkins H, Bayés‐de‐Luna A and Ashikaga H (2020) Association between interatrial block, left atrial fibrosis, and mechanical dyssynchrony: Electrocardiography‐magnetic resonance imaging correlation, Journal of Cardiovascular Electrophysiology, 10.1111/jce.14608, 31:7, (1719-1725), Online publication date: 1-Jul-2020. Rossi P, Cauti F, Limite L, Iaia L, Allegretti G, Di Renzi P, Longa G, Quaglione R, Piccirillo G and Bianchi S (2020) Interatrial conduction times in paroxysmal atrial fibrillation patients with normal atrial volume and their correlation with areas of local prolonged bipolar electrograms, Journal of Electrocardiology, 10.1016/j.jelectrocard.2019.09.017, 58, (19-26), Online publication date: 1-Jan-2020. Mendieta G, Guasch E, Weir D, Aristizabal D, Escobar-Robledo L, Llull L, Mont L, Bayés de Luna A and Sitges M (2020) Advanced interatrial block: A predictor of covert atrial fibrillation in embolic stroke of undetermined source, Journal of Electrocardiology, 10.1016/j.jelectrocard.2019.11.050, 58, (113-118), Online publication date: 1-Jan-2020. Buttà C, Crea P, Cimmino M, Ranieri F and Oreto G (2020) When the bundle skips a beat…, Journal of Cardiovascular Medicine, 10.2459/JCM.0000000000000865, 21:2, (153-155), Online publication date: 1-Feb-2020. Carmona Puerta R (2020) Interatrial blocks: Diagnosis and clinical significance, Medicina Clínica (English Edition), 10.1016/j.medcle.2020.03.008, 155:5, (207-214), Online publication date: 1-Sep-2020. Guerra J, Vilahur G, Bayés de Luna A, Cabrera J, Martínez‐Sellés M, Mendieta G, Baranchuk A and Sánchez‐Quintana D (2020) Interatrial block can occur in the absence of left atrial enlargement: New experimental model, Pacing and Clinical Electrophysiology, 10.1111/pace.13895, 43:4, (427-429), Online publication date: 1-Apr-2020. Fujimoto Y, Yodogawa K, Maru Y, Oka E, Hayashi H, Yamamoto T, Iwasaki Y, Hayashi M and Shimizu W (2018) Advanced interatrial block is an electrocardiographic marker for recurrence of atrial fibrillation after electrical cardioversion, International Journal of Cardiology, 10.1016/j.ijcard.2018.07.135, 272, (113-117), Online publication date: 1-Dec-2018. Baranchuk A and Yeung C (2018) Advanced interatrial block predicts atrial fibrillation recurrence across different populations: Learning Bayés syndrome, International Journal of Cardiology, 10.1016/j.ijcard.2018.08.025, 272, (221-222), Online publication date: 1-Dec-2018. Qiu H, Liu W, Lan T, Pan W, Chen X, Wu H and Xu D (2018) Salvianolate reduces atrial fibrillation through suppressing atrial interstitial fibrosis by inhibiting TGF-β1/Smad2/3 and TXNIP/NLRP3 inflammasome signaling pathways in post-MI rats, Phytomedicine, 10.1016/j.phymed.2018.09.238, 51, (255-265), Online publication date: 1-Dec-2018. Qiu H, Ji C, Liu W, Wu Y, Lu Z, Lin Q, Xue Z, Liu X, Wu H, Jiang W and Zou C (2018) Chronic Kidney Disease Increases Atrial Fibrillation Inducibility: Involvement of Inflammation, Atrial Fibrosis, and Connexins, Frontiers in Physiology, 10.3389/fphys.2018.01726, 9 January 9, 2018Vol 137, Issue 2 Advertisement Article InformationMetrics © 2018 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.117.032333PMID: 29311351 Originally publishedJanuary 9, 2018 PDF download Advertisement SubjectsArrhythmiasAtrial FibrillationElectrophysiology
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