A Comprehensive Review of Atrial Infarction

Abstract

Atrial infarction is often undiagnosed in patients with underlying ischemic heart disease and is identified only later, upon autopsy. One of the main challenges in diagnosing the condition is its localization within the affected atria. Treatment of atrial infarction focuses on acute reperfusion therapy, long-term management of cardiovascular disease risk factors, consideration of antiarrhythmia medications, and anticoagulation therapy. This review covers the anatomy of the atrial vasculature, complications associated with atrial infarction, diagnostic criteria for use of electrocardiography and other imaging modalities, and overall prognosis and management.

Keywords: Myocardial infarction; arrhythmias, cardiac; atrial function.

Fig. 1

The dotted circles represent the outline of the atrial walls. Black arrows detail perfusion territory. The coronary artery branches are numbered as follows: (1) right coronary artery, (2) right anterior atrial branch, (3) right intermediate atrial branch, (4) right posterior atrial branch, (5) Kugel arterial anastomotic branch, (6) left circumflex artery, (7) left anterior atrial branch, (8) left intermediate atrial branch, (9) left posterior atrial branch, (10) left atrial circumflex branch, and (11) atrioventricular nodal branch. LA, left atrium; RA, right atrium; SAN, sinoatrial node. Adapted from Boppana et al. Journal of Atrial Fibrillation. 4(3), 375. Used under the terms of the Creative Commons Attribution license. No permission required. http://www.jafib.com/open_access.php

Fig. 2

Schematic representation of the heart shows the 3 anatomic variations of the Kugel artery, arteria anastomotica auricularis magna, and superior view: (A) The arterial vessel arises from left circumflex artery, meeting with the vessels at the crux; (B) the vessel arises from the left circumflex artery or its branches and takes an abrupt turn to meet the vessels at the right atrium anterior wall; (C) the vessel arises from the left circumflex artery and fans out to meet with vessels from the right coronary artery. (1) Aorta, (2) pulmonary trunk, (3) mitral valve, (4) tricuspid leaflet, (5) atrioventricular nodal artery, (6) right coronary artery, (7) left circumflex artery, and (8), anastomotica auricularis magna. Adapted from Boppana et al. Journal of Atrial Fibrillation. 4(3), 375. Used under the terms of the Creative Commons Attribution license. No permission required. http://www.jafib.com/open_access.php

Fig. 3

(A) The sinus nodal artery does not reach the anterior interatrial groove; (B) the sinus nodal artery reaches the anterior interatrial groove but does not go beyond it; (C) the sinus nodal artery crosses the anterior interatrial groove; and (D) the left sinus nodal artery crosses the anterior interatrial groove. (1) Superior vena cava, (2) anterior interatrial groove, (3) aortic sinus, (4) right coronary artery, (5) appendage of the right atrium, (6) right sinus nodal artery, (7) left sinus nodal artery, and (8) left circumflex artery. Adapted from Boppana et al. Journal of Atrial Fibrillation. 4(3), 375. Used under the terms of the Creative Commons Attribution license. No permission required. http://www.jafib.com/open_access.php

Fig. 4

An electrocardiogram demonstrates criteria for atrial infarction—namely, a PR-segment depression in leads II, III, and aVF and a PR-segment elevation in lead aVR.