Interatrial Block and Supraventricular Arrhythmias: Clinical Implications of Bayés’ Syndrome

Edited by Adrian Baranchuk, MD

Forewords by Eugene Braunwald, MD, and Wojciech Zareba, MD, PhD

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ISBN: 9781942909156
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Published: January 2017
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About the book:

Bayés’ syndrome refers to the association between interatrial block and supraventricular arrhythmias—mainly the occurrence of atrial fibrillation. It is also a risk factor for cardio-embolic stroke. Rapid recognition by analyzing characteristic patterns in the surface ECG will help the physician to closely monitor the patient for atrial fibrillation and decide on anticoagulation therapy if the clinical risk of stroke is increased.

Interatrial blocks were described several decades ago; however, they are  now gaining the attention of the medical community as a means of helping to identify patients at high risk of developing atrial fibrillation and/or cardio-embolic stroke.

I welcome all readers to navigate this book and to become familiar with this concept that is helping to renovate our models of predicting atrial fibrillation and stroke.

Adrian Baranchuk, MD, FACC, FRCPC, FCCS
   Professor of Medicine (Tenure)
   Head, Heart Rhythm Service
   Queen's University
   Kingston, Ontario, Canada


Foreword by eugene braunwald, md:

Cardiologists are well acquainted with partial and complete blocks of conduction in the atrioventricular node, bundle of His, bundle branches, and within the ventricles. The prognostic implications and management of these blocks have been well described for decades. However, this has not been the case for blocks of interatrial conduction. While normal depolarization of the two atria and the bundle of myocardial fibers connecting them (Bachmann’s bundle) were described early in the twentieth century, the recognition of blocks in interatrial conduction leading to delayed activation and contraction of the left atrium came much later, and until relatively recently have received little attention.

Professor Antoni Bayés de Luna is a distinguished and highly respected Spanish cardiologist who is widely recognized as the leading figure in contemporary clinical electrocardiography. Among his many achievements is his work on interatrial conduction blocks, which he has pursued over almost four decades. Professor Bayés has studied, investigated, described, and taught the cardiology community about this subject. In addition to providing rigorous criteria for the diagnosis and classification of the severity of these conduction blocks, he has recognized and emphasized their important association with supraventricular tachyarrhythmias. Quite appropriately, this syndrome of interatrial conduction blockade associated with these arrhythmias, most often atrial flutter or fibrillation, has been named the “Bayés Syndrome.”

Professor Bayés has stimulated research around the world on this syndrome. It has been learned that the syndrome occurs with increasing frequency in the elderly and may be caused by ischemia, produced most commonly by atherosclerotic obstruction of the right coronary artery, as well as by atrial distension and/or fibrosis. Importantly, the Bayés syndrome appears to be a risk factor for cardio-embolic stroke. This has raised the possibility that preventive oral anticoagulant therapy, particularly with one of the newer oral anticoagulants, might be useful in patients with advanced interatrial block, even in the absence of clinically evident atrial fibrillation.

Interatrial Block and Supraventricular Arrhythmias: Clinical Implications of Bayés’ Syndrome, has been superbly edited by Adrian Baranchuk, an important clinical investigator of the syndrome. Baranchuk has thoughtfully and successfully pulled together the many threads of clinical research on the syndrome. This book will surely stimulate interest in what has been a largely neglected corner of cardiology. As a consequence of the outstanding work of Bayés, Baranchuk, and the authors who have contributed to this book, interatrial block is no longer a stepchild.

                                                                                                                                                -Eugene Braunwald, MD
                                                                                                                                                  Boston, Massachusetts


Table of Contents

Chapter 1     The Long Journey to the Diagnosis of Interatrial Blocks: ECG-VCG Criteria
                       Antoni Bayés de Luna and Adrian Baranchuk

Chapter 2     Normal Electrical Atrial Activity
                       
Pyotr G. Platonov

Chapter 3     Structure of the Bachmann bundle
                       
José Angel Cabrera and Damián Sánchez-Quintana

Chapter 4     Physiopathology of the Interatrial Blocks
                        
Antoni Bayés de Luna, Albert Massó van-Roessel, and Luis Alberto Escobar Robledo                             

Chapter 5     Contributions of Noncontact Mapping to the Understanding of Normal Atrial Activation
                       
Colin Yeo, Robert Lemery, and Martin Green

Chapter 6     Contributions of Noncontact and Contact Mapping to the Understanding of Interatrial Block
                       Benedict M. Glover

Chapter 7     Epidemiology of Interatrial Block
                        Shreyas Gowdar, Lovely Chhabra, and David H. Spodick                                                  

Chapter 8     Consensus Document on Interatrial Blocks: 2016 Update
                       Antoni Bayés de Luna, Iwona Cygankiewicz, Javier García-Niebla, and Francisco G. Cosío

Chapter 9     Interatrial Block and Supraventricular Arrhythmias: Bayés’ Syndrome
                       
Diego Conde and Adrian Baranchuk

Chapter 10    Correlation of Interatrial Block with Left Atrial Enlargement and P-wave Terminal Force
                        
Larisa G. Tereshchenko

Chapter 11     Interatrial Block and Stroke
                        Arun Gautam, Lovely Chhabra, and David H. Spodick                             

Chapter 12     Interatrial Block as a Predictor of Atrial Fibrillation
                        
Andres Enriquez and Diego Conde

Chapter 13     Interatrial Block as a Predictor of Post-CABG Atrial Fibrillation
                         Erik M. van Oosten and Adrian Baranchuk                                             

Chapter 14     Interatrial Block in Octogenarians and Up
                       
Manuel Martínez-Sellés and Antoni Bayés de Luna

Chapter 15    Interatrial Block in Hemodialysis Patients
                          Marco Marano    

Chapter 16     Interatrial Block in Severe Heart Failure and the Impact of Cardiac Resynchronization Therapy
                        Fariha Sadiq Ali, Roger Villuendas, and Antoni Bayés-Genís

Chapter 17     Interatrial Block in Patients with Sleep Apnea and the Impact of CPAP
                        Adrian Baranchuk and Benedict Glover

Chapter 18     Progressive Interatrial Block
                        
Bryce Alexander and Adrian Baranchuk

Chapter 19     Atrial Resynchronization by Biatrial Pacing: Is This a Solution?
                        Jean-Claude Daubert, Raphaël Martins, and Philippe Mabo

Chapter 20     The Future (and Challenge) of Treating Interatrial Block in the 21st Century
                         Ignacio Fernández-Lozano, Diego Jiménez Sánchez, Eusebio García Izquierdo, and Antoni Bayés de Luna


Doody's Review Service

Reviewer
Ahmet Oktay,  MD(Ochsner Clinic Foundation)

Description
This book provides a comprehensive, evidence-based, and clinically oriented insight into interatrial blocks.

Purpose
The purpose is to provide broad knowledge and practical insights about all aspects of interatrial block and its relationship with cardiac and noncardiac comorbidities. This book fulfills its purpose.

Audience
It is appropriate for general cardiologists, electrophysiologists, and researchers who focus on cardiac rhythm disorders. This book will also be useful for cardiology fellows who would like to gain in-depth knowledge on interatrial blocks and Bayes' syndrome. Antoni Bayes de Luna, a world renowned expert on clinical electrocardiography, is one of the contributing authors.

Features
The book begins with chapters on the normal atrial electrical activity and interatrial conduction system, and the historical background of research on interatrial blocks. It then covers the pathophysiology, epidemiology, and diagnosis of interatrial blocks. The relationship between interatrial blocks, supraventricular tachycardias, and other cardiac and noncardiac conditions is discussed in detail. The last chapters of the book focus on the concepts of atrial resynchronization and future perspectives on the treatment of interatrial block.

Assessment
Clinical research (mainly stimulated by Dr. Bayes) has broadened the understanding of interatrial blocks and its clinical implications. But still, the knowledge and awareness of interatrial blocks remain limited when compared to the data on clinical implications and management of atrioventricular or infranodal blocks. Epidemiological studies now indicate that interatrial blocks occur more frequently than it was once thought. Supraventricular arrhythmias commonly occur in the setting of interatrial block, which is now defined as Bayes' syndrome. Moreover, interatrial block has been associated with noncardiac comorbidities such as stroke, cognitive impairment, and dementia. This book, the first on this topic, is a very important contribution to the field of clinical electrophysiology. Moreover, it will stimulate further research.