Advanced interatrial block: a well-defined electrocardiographic pattern with clinical arrhythmological implications

Abstract

We read with interest Hinojar et al .1 case recently published in the journal. Their case wisely demonstrated the presence of P-wave with +/− morphology in leads II, III, and aVF as a pattern of advanced interatrial block (IAB). This pattern has been also called ‘block in the Bachmann bundle zone’ since Waldo obtained this electrocardiogram (ECG) pattern by cutting the Bachmann bundle at both sides of the septum [right and left atrium (LA)].2 The electroanatomical mapping (CARTO) showed by Hinojar et al. in sinus rhythm clearly shows that the atrial activation starts normally, but its propagation is blocked along the LA roof and the high lateral activation is delayed and directed caudocraneally starting at the posteroinferior LA region. Therefore, this type of atrial activation …