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
