Learning More About Interatrial Block ...

Dhanunjaya Lakkireddy

Dear colleagues

Welcome to this issue of JAFIB. Congratulations to the APHRS team on a very successful Annual Meeting in Bangkok, Thailand! It was a well rounded meeting with excellent science being discussed. While cold blasts started hitting North America it was warm in this subtropical haven of amazing cuisine and culture.

Science related to Atrial Fibrillation (AF) continues to move forwards despite all the unrest around the world. In this issue of JAFIB, we have three manuscripts on inter atrial block. This apparently common electrocardiographic finding may have some very interesting diagnostic, therapeutic and prognostic implications. All in all, this may reflect the patient risk factor profile and atrial pathology that predicts a higher prevalence of AF and probably poor outcomes of therapy. A meta-analysis of the relationship between LAA morphology and systemic thromboembolism confirms the original findings of the Austin group that non-chicken wing morphology is predictive of higher event rates. Even though oversimplification of the anatomy into the four classic categories is often criticized it is possibly the most practical way of classifying left atrial appendages. The chicken wing and wind sail morphologies are probably less complex in their anatomic variation. Multiple lobes and more complex branching obviously increase the thrombogenicity of these LAAs. More recent work from Bartus etal (HEART Clot study) may provide more insights into the regional factors that play a role in explaining the individual variations in atrial thrombogenicity. Another systematic review of endocardial LAA closure device related complications highlights the potential for pulmonary, coronary and valve injury. Though rare it is important to understand these issues and be able to promptly recognize and treat and possibly prevent them. Case reports that highlight the impact of coronary ischemia on conduction system abnormalities and unusual causes of cardiac resynchronization therapy non-response.

The Indian Heart Rhythm Society (IHRS) has successfully organized their 11th Annual meeting in New Delhi. Physiologic pacing and Complex supraventricular tachycardia ablation took the main stage. On behalf of the JAFIB team we wish you all a happy Thanksgiving.


Dhanunjaya (DJ)Lakkireddy MD, FACC, FHRS Editor-in-Chief JAFIB