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Características diferenciales del bloqueo interauricular avanzado típico y atípico / Differential characteristics of the typical and atypical advanced interatrial block
Gentille-Lorente, Delicia; Salvadó-Usach, Teresa.
  • Gentille-Lorente, Delicia; Hospital de Tortosa Verge de la Cinta. Servicio de Cardiología. Tarragona. ES
  • Salvadó-Usach, Teresa; Hospital de Tortosa Verge de la Cinta. Servicio de Anatomía Patológica. Tarragona. ES
Arch. cardiol. Méx ; 90(3): 266-273, Jul.-Sep. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1131043
RESUMEN
Resumen

Objetivo:

Se denomina bloqueo interauricular avanzado (BIA) a la existencia de una onda P ≥ 120 ms y bifásica +/- en las derivaciones inferiores (II-III-VF) del electrocardiograma (ECG) de superficie, el cual constituye un factor predictivo significativo del desarrollo de fibrilación auricular. En fecha reciente se han descrito cuatro patrones de BIA atípicos (BIA-At) con base en la morfología y la duración de la onda P, sin conocer si comparten patogenia y características clínicas similares.

Método:

Estudio observacional, descriptivo y retrospectivo de pacientes, visitados en el Servicio de Cardiología, en ritmo sinusal y con BIA. Las variables analizadas se obtuvieron de la historia clínica informatizada. El análisis de la onda P se efectuó al aumentar el tamaño del electrocardiograma y mediante calipers electrónicos. El análisis estadístico se realizó con SPSS 19.0, con nivel de significación de p < 0.05.

Resultados:

Se incluyó a 75 pacientes con media de edad de 74.4 ± 11.7 años, con 62.7% de varones. Se compararon los grupos de pacientes con BIA típico (BIA-T) y BIA-At. El primero se relacionó con la existencia de diabetes mellitus (p = 0.001), enfermedad renal crónica estadio ≥ 3 (p = 0.036), bloqueo auriculoventricular (p = 0.006) y una menor fracción de expulsión ventricular media (p = 0.025); no hubo diferencias respecto de la prevalencia de fibrilación auricular/flúter o accidente cerebrovascular. Sólo la diabetes se acompañó de riesgo de ser un BIA-T (OR 6.4; p = 0.002; IC 95% 2.0-21.1).

Conclusiones:

La diabetes mellitus constituye el único factor de riesgo de que un BIA sea típico. Los pacientes con BIA-T y BIA-At presentan similar prevalencia de fibrilación auricular y accidente cerebrovascular, por lo que son objeto de un mismo tratamiento clínico.
ABSTRACT
Abstract

Objective:

It is called advanced interatrial block (IAB) to the existence of a P wave ≥ 120 ms and biphasic ± in the lower leads II-III-VF of the surface electrocardiogram (ECG), which constitutes a significant predictive factor for the development of atrial fibrillation. Recently, four patterns of atypical aIAB (At-IAB) have been described based on the morphology and duration of the P wave, but it’s unknown if they share the same pathogenesis and clinical characteristics.

Method:

An observational, descriptive and retrospective study was performed with patients, visited in cardiology, who have a sinus rhythm and with aIAB. The analyzed variables were obtained from the computerized clinical history. The analysis of the P wave was made by increasing the size of the ECG and by electronic calipers. Statistical analysis was performed with SPSS 19.0; level of

significance:

p < 0.05.

Results:

A total of 75 patients with an average age of 74.4 ± 11.7 years and with a 62.7% males, were included. It was compared the group of patients with typical aIAB (T-aIAB) and with At-aIAB. The first one was associated with the existence of diabetes mellitus (p = 0.001), chronic kidney disease stage ≥ 3 (p = 0.036), atrioventricular block (p = 0.006) and a lower mean ventricular ejection fraction (p = 0.025); there were no differences regarding the prevalence of atrial fibrillation/flutter or stroke. Only diabetes was associated with the risk of T-aIAB (odds ratio 6.4; p = 0.002; 95% confidence interval 2.0-21.1).

Conclusions:

Diabetes mellitus is the only risk factor for an aIAB to be typical. Patients with T-aIAB and At-aIAB have a similar prevalence of atrial fibrillation and stroke, so they must follow the same clinical management.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Atrial Fibrillation / Electrocardiography / Interatrial Block Type of study: Diagnostic study / Etiology study / Observational study / Prevalence study / Prognostic study / Risk factors Limits: Aged / Aged80 / Female / Humans / Male Language: Spanish Journal: Arch. cardiol. Méx Journal subject: Cardiology Year: 2020 Type: Article Affiliation country: Spain Institution/Affiliation country: Hospital de Tortosa Verge de la Cinta/ES

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Full text: Available Index: LILACS (Americas) Main subject: Atrial Fibrillation / Electrocardiography / Interatrial Block Type of study: Diagnostic study / Etiology study / Observational study / Prevalence study / Prognostic study / Risk factors Limits: Aged / Aged80 / Female / Humans / Male Language: Spanish Journal: Arch. cardiol. Méx Journal subject: Cardiology Year: 2020 Type: Article Affiliation country: Spain Institution/Affiliation country: Hospital de Tortosa Verge de la Cinta/ES