Acute atrial infarction: a relatively neglected and under-recognized entity in clinical practice

Area of Science:

• Cardiology
• Cardiovascular Research
• Medical Diagnostics

Background:

• Acute atrial infarction (AAI) and its electrocardiogram (ECG) and angiographic indicators are frequently overlooked in clinical practice.
• Under-recognition of AAI can lead to delayed or missed diagnoses, impacting patient outcomes.

Purpose of the Study:

• To determine the incidence of AAI in patients with acute coronary syndrome (ACS) undergoing angiography.
• To analyze the angiographic and ECG characteristics associated with AAI based on the infarct-related artery.

Main Methods:

• Retrospective observational study of 3981 patients with ACS undergoing angiography.
• Identification of patients meeting angiographic criteria for AAI.
• Comparison of ECG findings (PR-segment deviation, atrial tachyarrhythmia, P wave abnormalities, sinus bradycardia/arrest) between groups with different infarct-related arteries (right coronary artery vs. left circumflex artery).

Main Results:

• 270 patients (6.78%) were diagnosed with AAI.
• The right coronary artery was the infarct-related artery (IRA) in 187 patients (Group R), and the left circumflex artery in 83 patients (Group L).
• Group L showed a significantly higher prevalence of P wave abnormalities (49.4% vs. 29.9%) and sinus bradycardia/arrest (66.3% vs. 25.1%) compared to Group R.

Conclusions:

• Acute atrial infarction is a distinct clinical entity that is often missed.
• Clinicians should be aware of AAI and its potential complications, including atrial arrhythmias, thromboembolism, hemodynamic instability, and atrial rupture.