ATRIAL INFARCTION
https://doi.org/10.57256/2949-0715-2026-5-1-40-51
Abstract
Background. Atrial infarction is a common but often undiagnosed disease. The lack of clear and reliable diagnostic criteria, as well as the lack of awareness among doctors are the reasons for this state of affairs. The right diagnosis with detection of an infarct-related atrial artery and restoration of blood flow will prevent complications and improve the prognosis
Aim. To analyze the data of literature on the etiology of atrial infarction, diagnostic possibilities and the role of diagnostic methods, including electrocardiography, transesophageal echocardiography, and coronary angiography.
Results. Atrial infarction occurs due to atherosclerotic lesions of the atrial arteries. It is also described in pulmonary hypertension, atrial embolism, complications of percutaneous coronary interventions or ablation of the left atrium. Atrial infarction can be combined with inferior infarction of the left ventricle and with infarction of the right ventricle, which is associated with the joint blood supply. Isolated atrial infarction is possible, more often the right one. Diagnosis of atrial infarction is difficult. Electrocardiographic criteria for atrial infarction do not have sufficient sensitivity and specificity. Transesophageal echocardiography makes it possible to assess atrial wall akinesia and atrial thrombus. It is important to assess atrial branches with coronary angiography. The most common complications are supraventricular arrhythmias, bradycardia, thromboembolic complications, and atrial rupture with tamponade. The main treatment method is reperfusion therapy.
Conclusion. Diagnosis of atrial infarction is difficult. To make a diagnosis it is important to search for signs of atrial infarction using a comprehensive examination, including coronary angiography.
About the Author
Elena Sergeevna Eniseeva
Irkutsk State Medical University;
Irkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuing Professional Education
Russian Federation
Russian Federation
Cand. Sci. (Med.), associated professor
References
1. Clerc A., Levy R. Infarctus auriculaire: tachyarrhythmia terminale. Bull Mem Sot Med Hop Paris 1925;41:1603-1607
2. Hellerstein H.K. Atrial infarction with diagnostic electrocardiographic findings. Am Heart J. 1948;36(3):422-430. https://doi.org/10.1016/0002-8703(48)90338-x
3. Lazar E.J., Goldberger J., Peled H., Sherman M., Frishman W.H. Atrial infarction: diagnosis and management. Am Heart J. 1988;116(4):1058-1063. https://doi.org/10.1016/0002-8703(88)90160-3
4. Gardin J.M., Singer D.H. Atrial infarction. Importance, diagnosis, and localization. Arch. Intern. Med. 1981;141:1345-1348. https://doi.org/10.1001/archinte.141.10.1345
5. Shakir D.K., Arafa S.O.E. Right atrial infarction, atrial arrhythmia and inferior myocardial infarction form a missed triad: A case report and review of the literature. Can J Cardiol. 2007;23(12):995 997. https://doi.org/10.1016/s0828-282x(07)70864-4
6. Radojevic N., Savic S., Assist V.A., Cukic D. Unusual case of right atrial reinfarction. J Forensic Leg Med. 2012;19(2):105-108. https://doi.org/10.1016/j.jflm.2011.10.003
7. Yıldız S.S., Keskin K., Avsar M. et al. Electrocardiographic diagnosis of atrial infarction in patients with acute inferior ST-segment elevation myocardial infarction. Clin. Cardiol. 2018;41:972–977. https://doi.org/10.1002/clc.22987
8. Di C., Wang H., Wang M. et al. Acute atrial infarction: a relatively neglected and under-recognized entity in clinical practice. Herz. 2025;50(2):122-134. https://doi.org/10.1007/s00059-024-05272-z
9. Ventura T., Colantonio D., Leocata P. et al. Isolated atrial myocardial infarction: pathological and clinical features in 10 cases. Cardiologia.1991;36:345 50. URL: https://pubmed.ncbi.nlm.nih.gov/1756539/ [accessed: 05.11.2025]
10. Marmagkiolis K., Hakeem A., Cilingiroglu M. Isolated right atrial infarction from occluded non-dominant right coronary artery. Rev Port Cardiol. 2014;33:123-124. https://doi.org/10.1016/j.repc.2013.07.019
11. Wong A.K., Marais H.J., Jutzy K., Capestany G.A., Marais G.E. Isolated atrial infarction in a patient with single vessel disease of the sinus node artery. Chest. 1991;100(1):255-6. https://doi.org/10.1378/chest.100.1.255
12. Cunningham K.S., Chan K.L., Veinot J.P. Pathology of isolated atrial infarction: case report and review of the literature. Cardiovasc Pathol. 2008;17(3):183-5. https://doi.org/10.1016/j.carpath.2007.05.002
13. Boppana V.S., Castaño A., Avula U.M.R., Yamazaki M., Kalifa J. Atrial Coronary Arteries: Anatomy And Atrial Perfusion Territories. J Atr Fibrillation. 2011;4(3):375. https://doi.org/10.4022/jafib.375
14. Vikse J., Henry B.M., Roy J. et al. Anatomical Variations in the Sinoatrial Nodal Artery: A Meta-Analysis and Clinical Considerations. PLoS One 2016;11(2):e0148331. http://doi.org/10.1371/journal.pone.0148331
15. Nerantzis С.E., Anninos H., Marianou S.K., Pastromas S. The behavior of three types of large sinus node arteries with regard to the blood supply of the atrial myocardium Surg Radiol Anat. 2021;43(3):311-316. https://doi.org/10.1007/s00276-020-02621-5
16. Nerantzis C., Anninos H., Koutsaftis P. Variation in the blood supply of the sinus node. Surg Radiol Anat.2010; 32(10):983–4. https://doi.org/10.1007/s00276-010-0635-3
17. Lu M.L.R., De Venecia T., Patnaik S., Figueredo V.M. Atrial myocardial infarction: a tale of the forgotten chamber. Int. J. Cardiol. 2016;202:904-909. https://doi.org/10.1016/j.ijcard.2015.10.070
18. Stewart W.J. Atrial myocardial infarction: a neglected stalker in coronary patients. J Am Coll Cardiol. 2017;70(23):2890-2892. https://doi.org/10.1016/j.jacc.2017.10.015
19. Álvarez-García J., Vives-Borrás M., Ferrero A. et al. Atrial coronary artery occlusion during elective percutaneous coronary angioplasty. Cardiovasc. Revasculariz. Med. 2013;14:270-274. https://doi.org/10.1016/j.carrev.2013.07.007
20. Álvarez-García J., Vives-Borrás M., Gomis P. et al. Electrophysiological Effects of Selective Atrial Coronary Artery Occlusion in Humans. Circulation. 2016;133(23):2235-2242. https://doi.org/10.1161/CIRCULATIONAHA.116.021700
21. Koren O., Antonelli D., Khamaise R. et al. Sinus node dysfunction due to occlusion of the sinus node artery during percutaneous coronary intervention. J Interv Cardiol. 2021;2021:8810484.. https://doi.org/10.1155/2021/8810484
22. Maeda T., Yamashita S., Kuroda K., Okuda M. Isolated atrial infarction complicated by sick sinus syndrome and atrial fibrillation: a case report. Eur Heart J Case Rep. 2024;9(1):ytae692. https://doi.org/10.1093/ehjcr/ytae692
23. Nikus K, Birnbaum Y, Fiol-Sala M, Rankinen J, de Luna AB. Conduction Disorders in the Setting of Acute STEMI. Curr Cardiol Rev. 2021;17(1):41-49. https://doi.org/10.2174/1573403X16666200702121937
24. Miyazaki Y., Ueda N., Otsuka F. et al. Rescue percutaneous coronary intervention for sinus node dysfunction following left atrial flutter ablation. HeartRhythm Case Rep 2021;7:529-532. https://doi.org/10.1016/j.hrcr.2021.04.015
25. Fujiwara M., Yamashita S., Takemoto M., Hayashi T. Atrial tachycardia related to atrial infarction treated with catheter ablation: a case report. Eur Heart J Case Rep. 2022;6(8):ytac346. https://doi.org/10.1093/ehjcr/ytac346
26. Grosso D., Dickman J., Valencia D. A Comprehensive Review of Atrial Infarction. Tex Heart Inst J. 2024;51(2):e238334. https://doi.org/10.14503/THIJ-23-8334
27. Langendorf R. Elektrokardiogramm bei Vorhof‐Infarkt. Acta Medica Scandinavica. 1939;100(1 2):136-149. https://doi.org/10.1111/j.0954-6820.1939.tb14983.x
28. Liu C.K., Greenspan G., Piccirillo R.T. Atrial infarction of the heart. Circulation. 1961;23:331-338. https://doi.org/10.1161/01.cir.23.3.331
29. Riera A.R.P., Barros R.B., Neto A.F.S.E.S., Raimundo R.D., de Abreu L.C., Nikus K. Extensive Anterior Myocardial Infarction...and Something Else? Arq Bras Cardiol. 2019;112(6):803-806. https://doi.org/10.5935/abc.20190096
30. Neven K., Crijns H., Gorgels A. Atrial infarction: a neglected electrocardiographic sign with important clinical implications. J Cardiovasc Electrophysiol. 2003;14:306 308. URL: https://pubmed.ncbi.nlm.nih.gov/12716115/ [accessed: 05.11.2025]
31. Nielsen F.E., Andersen H.H., Gram-Hansen P., Sørensen H.T., Klausen I.C. The relationship between ECG signs of atrial infarction and the development of supraventricular arrhythmias in patients with acute myocardial infarction. Am Heart J. 1992;123(1):69-72. https://doi.org/10.1016/0002-8703(92)90748-k
32. Cristal N., Peterburg I., Invar-Yanai I. Atrial infarction leading to rupture. British Heart journal. 1979;41:350-353. https://doi.org/10.1136/hrt.41.3.350
33. Kakizaki R., Imaki R., Ako J. Right atrial infarction causing recurrent cardiac rupture and cardiac tamponade. Eur Heart J Case Rep. 2023;7:1-2. https://doi.org/10.1093/ehjcr/ytad534
34. Корнев Н.И., Переверзева К.Г., Якушин С.С., Глуховец И.Б. Инфаркт миокарда "забытой камеры сердца" — правого предсердия: клинический случай. Рациональная Фармакотерапия в Кардиологии. 2024;20(6):660-668 [Kornev N.I., Pereverzeva K.G., Yakushin S.S., Glukhovets I.B. Myocardial infarction of the "forgotten chamber of the heart" — the right atrium: a clinical case. Rational Pharmacotherapy in Cardiology. 2024;20(6):660-668 (In Russ.)]. https://doi.org/10.20996/1819-6446-2024-3108
35. Jim M-H., Siu C-W., Chan AO-o. et al. Prognostic implications of PR-segment depression in inferior leads in acute inferior myocardial infarction. Clin Cardiol. 2006;29(8):363-368. https://doi.org/10.1002/clc.4960290809
36. Lu M.L.R., Nwakile C., Bhalla V. et al. Prognostic Significance of Abnormal P Wave Morphology and PR-Segment Displacement after ST-Elevation Myocardial Infarction. Int J Cardiol. 2015;197:216-221. https://doi.org/10.1016/j.ijcard.2015.06.055
37. Amorós-Figueras G., Roselló-Diez E., Sanchez-Quintana D. et al. Changes in local atrial electrograms and surface ECG induced by acute atrial myocardial infarction. Front Physiol. 2020;11:264. https://doi.org/10.3389/fphys.2020.00264
38. Demidova M.M., Olivecrona G., Gorgels A.P.M., Erlinge D., Platonov P.G. Lack of atrial branch perfusion during acute ischemia is not associated with new-onset atrial fibrillation during STEMI. IJC Heart & Vasculature. 2025;58:101668. https://doi.org/10.1016/j.ijcha.2025.101668
39. Duque-González L., Orrego-Garay M.J., Lopera-Mejía L., Duque-Ramírez M. Atrial infarction: a literature review. Cardiovascular and Metabolic Science. 2020;31(1):17-24. https://doi.org/10.35366/93258
40. Hosseinsabet A., Salarifar M. Right atrial appendage thrombosis in a patient with a history of myocardial infarction. J Cardiovasc Echogr. 2021;31:55-56. https://doi.org/10.4103/jcecho.jcecho_76_20
41. Hilton T.C., Pearson A.C., Serota H., Dressler F.A., Kern M.J. Right atrial infarction and cardiogenic shock complicating acute myocardial infarction: diagnosis by transesophageal echocardiography. Am Heart J. 1990;120(2):427-430. https://doi.org/10.1016/0002-8703(90)90091-b
42. Vargas-Barrón J., López-Meneses M., Roldán F-J. et al. The impact of right atrial ischemia on inferior myocardial infarction with extension to right ventricle: transesophageal echocardiographic examination. Clin Cardiol. 2002;25(4):181-6. https://doi.org/10.1002/clc.4960250409
43. Aguero J., Galan-Arriola C., Fernandez-Jimenez R. et al. Atrial infarction and ischemic mitral regurgitation contribute to post-MI remodeling of the left atrium. J Am Coll Cardiol. 2017;70(23):2878-2889. https://doi.org/10.1016/j.jacc.2017.10.013
44. Tjandrawidjaja M.C., Fu Y., Kim D.H. et al. Compromised atrial coronary anatomy is associated with atrial arrhythmias and atrioventricular block complicating acute myocardial infarction. J Electrocardiol. 2005;38(3):271-278. https://doi.org/10.1016/j.jelectrocard.2005.01.013
45. Platonov P.G. P-Wave Morphology: Underlying Mechanisms and Clinical Implications. Ann Noninvasive Electrocardiol. 2012;17(3):161–169. https://doi.org/10.1111/j.1542-474X.2012.00534.x
46. van Diepen S., Siha H., Fu Y. et al. Do baseline atrial electrocardiographic and infarction patterns predict new-onset atrial fibrillation after ST-elevation myocardial infarction? Insights from the Assessment of Pexelizumab in Acute Myocardial Infarction Trial. J Electrocardiol. 2010;43(4):351-358. https://doi.org/10.1016/j.jelectrocard.2010.04.001
47. Wojcik M. Co-existence of Atrial Fibrillation with Myocardial Infarction - Unhealthy Combination. J Atr Fibrillation. 2012;5(4):666. https://doi.org/10.4022/jafib.666
48. Blanton R.M., Nappi A., Carey D., Kimmelstiel C.D. Conversion of infarction-associated atrial fibrillation by restoration of atrial perfusion. Clin. Cardiol. 2010;33(12):E79-E81. https://doi.org/10.1002/clc.20573
49. Shiba T., Kondo Y., Senoo K. et al. Proximal Occlusion in the Right Coronary Artery Involving the Atrial Branch as a Strong Predictor of New-Onset Atrial Fibrillation in Acute Myocardial Infarction. Int Heart J. 2019;60(6):1308-1314. https://doi.org/10.1536/ihj.18-713
50. Alasady M., Abhayaratna W.P., Leong D.P. et al. Coronary artery disease affecting the atrial branches is an independent determinant of atrial fibrillation after myocardial infarction. Heart Rhythm. 2011;8(7):955-60. https://doi.org/10.1016/j.hrthm.2011.02.016
51. Alasady M., Shipp N.J., Brooks A.G. et al. Myocardial infarction and atrial fibrillation: importance of atrial ischemia. Circ Arrhythm Electrophysiol. 2013;6:738–745. https://doi.org/10.1161/CIRCEP.113.000163
52. Sinno H., Derakhchan K., Libersan D. et al. Atrial ischemia promotes atrial fibrillation in dogs. Circulation 2003;107:1930–1936. https://doi.org/10.1161/01.CIR.0000058743.15215.03
53. Avula U.M.R., Hernandez J.J., Yamazaki M. et al. Atrial Infarction-Induced Spontaneous Focal Discharges and Atrial Fibrillation in Sheep: Role of Dantrolene-Sensitive Aberrant Ryanodine Receptor Calcium Release. Circ Arrhythm Electrophysiol. 2018;11(3):e005659. https://doi.org/10.1161/CIRCEP.117.005659
54. Nishida K., Qi X.Y., Wakili R. et al. Mechanisms of atrial tachyarrhythmias associated with coronary artery occlusion in a chronic canine model. Circulation. 2011;123:137 146. https://doi.org/10.1161/CIRCULATIONAHA.110.972778
55. Wang J., Yang Y.M., Zhu J. Mechanisms of new-onset atrial fibrillation complicating acute coronary syndrome. Herz. 2015;40(Suppl 1):18–26. https://doi.org/10.1007/s00059-014-4149-3
56. Rao J., Yu Y., Cheng P. et. Relationship between myocardial infarction and atrial fibrillation: A bidirectional Mendelian randomization study. Medicine (Baltimore). 2024;103(44):e40252. https://doi.org/10.1097/MD.0000000000040252
57. Pokorney S.D., Berchuck S.I., Chiswell K. et al. Atrial branch coronary artery stenosis as a mechanism for atrial fibrillation. Heart Rhythm. 2022;19(8):1237-1244. https://doi.org/10.1016/j.hrthm.2021.12.020
58. Çinier G., Tekkeşin A.I., Genç D. et al. Interatrial block as a predictor of atrial fibrillation in patients with ST-segment elevation myocardial infarction. Clin Cardiol. 2018;41(9):1232-1237. https://doi.org/10.1002/clc.23029
59. Kawamura Y., Yokoyama H., Kitayama K. et al. Clinical impact of complete atrioventricular block in patients with ST-segment elevation myocardial infarction. Clin Cardiol. 2021;44(1):91-99. https://doi.org/10.1002/clc.23510
Review
For citations:
Eniseeva E.S. ATRIAL INFARCTION. Baikal Medical Journal. 2026;5(1):40-51. (In Russ.) https://doi.org/10.57256/2949-0715-2026-5-1-40-51
Views:
122
JATS XML
