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Interatrial Block*: Pandemic Prevalence, Significance, and Diagnosis

Vignendra Ariyarajah, MD; Navrid Asad, MD; Anwar Tandar, MD; David H. Spodick, MD, DSc, FCCP
Author and Funding Information

*From the Division of Cardiology, Department of Medicine, Saint Vincent Hospital, Worcester Medical Center, Worcester, MA.

Correspondence to: David H. Spodick, MD, DSc, FCCP, Professor of Medicine, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655; e-mail: spodickd@ummhc.org



Chest. 2005;128(2):970-975. doi:10.1378/chest.128.2.970
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Interatrial block (IAB) [P-wave duration ≥ 110 ms] is well described but poorly recognized since it was first noted experimentally in 1925 and clinically in 1965. Its high prevalence was demonstrated in two well-separated general hospital populations.12. IAB is important because it is associated with abnormal atrial excitability leading to atrial fibrillation and other arrhythmias,37 significant electromechanical dysfunction of the left atrium (LA),78 LA thrombosis, and systemic embolism.3,78 However, both IAB and its consequences are widely overlooked, at least partly because many textbooks in general medicine911 and even in cardiology1214 fail to discuss and, in most cases, even mention IAB and its ominous association with other clinical conditions, such as atrial fibrillation and flutter.37 Moreover, even articles3 recognizing IAB and its diagnostic, functional, or arrhythmic associations underreport its prevalence by restricting investigations either to lead II alone or cite only one or two other leads. These omissions limit awareness, which is the key to timely detection and recognition of IAB, as well as anticipation and even prevention of sequelae. Our purposes are to define IAB, discuss investigations reporting its remarkable prevalence and its grave associations with other conditions, and propose a sound approach to its diagnosis as prolonged conduction between the right atrium (RA) and LA.15

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