The frequency of atrial infarction in patients with supraventricular arrhythmias

Aim      To evaluate the incidence of atrial infarction (AI) based on a retrospective review of 287 case reports of patients with supraventricular arrhythmia and a positive qualitative test for troponin I after pharmacological arrest of arrhythmia; to determine the target localization of lesions and diagnostic signs, that appear in acute ischemic atrial damage, by selective coronary angiography (CA).

Material and methods  A retrospective review was performed of 287 case reports of patients admitted to cardiology departments for atrial fibrillation paroxysm with narrow QRS complexes on electrocardiogram (ECG) from 2018 through 2020. At the prehospital stage, verapamil had been administered intravenously with no effect. In the hospital, the sinus rhythm was successfully restored pharmacologically in all patients. Then ECG, repeated qualitative determination of troponin I, echocardiography, and CA were performed.

Results 77 (27 %) patients of the study group had AI signs; 27 (9.5 %) of these patients had confirmed AI, and 50 (17.5 %) patients had probable AI. The existence of acute ischemic injury was considered absolutely confirmed in the presence of a combination of ECG changes, positive markers of myocardial damage, and reduced blood flow velocity in the left atrial branch of the sinoatrial nodal artery as shown by CA; in the presence of only ECG and biochemical criteria, acute AI was considered probable. According to selective CA, coronary injuries requiring an intervention were absent, and signs of the above-mentioned artery thrombosis were not visualized. However, the blood flow velocity was reduced to the TIMI II level in 9.5 % of cases; other atrial branches had an extremely small diameter.

Conclusion      Atrial infarction needs to be excluded for patients with supraventricular arrhythmias, a characteristic clinical picture, and increased levels of myocardial injury enzymes.

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