Detection of concurrent atrial ischemia with continuous monitoring of dynamic PR-segment changes in patients with acute myocardial infarction

Despite its potential prognostic value concurrent atrial ischemia is often overlooked in patients with acute myocardial infarction (AMI). There is no study concerning the relationship between atrial coronary circulation and dynamic PR-segment changes in patients with AMI. We evaluated dynamic PR-segment changes in 37 patients with AMI. The flow in the principal atrial coronary branches was diminished in 14 (38%) patients. Dynamic changes in the PR-segment level [median 47 (inter quartile range 19–55) μV vs. 23 (18–30) μV, P = 0.005] and PR-segment area [3.15 (1.75-3.69) nVs vs. 1.62 (1.18-2.04) nVs, P = 0.005] were significantly greater in patients with compromised than in those with normal flow in the atrial coronary branches. Our findings support the concept that atrial ischemia produces similar changes in the PR-segment as ventricular ischemia in the ST-segment. Given the possible deleterious consequences of atrial ischemia these data may have important clinical implications in evaluation of patient with AMI.