Background: Patterns of left ventricular hypertrophy and geometric remodeling have previously been investigated extensively in patients with hypertension and valvular heart diseases. However, the relationship between these patterns and atrial fibrillation (AF) remains unknown. Methods: We retrospectively analyzed 4455 patients who had simultaneously undergone both transthoracic echocardiography and an electrocardiogram at our hospital during the year 2013. Patients who underwent emergency transthoracic echocardiography and those with findings of previous myocardial infarctions were excluded. We calculated the left ventricular mass index (LVMI) and relative wall thickness (RWT) according to the calculation formula and categorized the 4074 patients into four groups as follows: normal geometry (n = 2954), concentric remodeling (normal LVMI and high RWT, n = 378), concentric hypertrophy (high LVMI and high RWT, n = 172), and eccentric remodeling (high LVMI and normal RWT, n = 570). Results:The mean left atrial diameters were found to be 34.9, 35.2, 39.3, and 40.6 mm in patients with normal geometry, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy, respectively. The mean ejection fractions were 61.8, 62.4, 61.0, and 53.8%; while the prevalence of AF was 8.1, 8.5, 11.3, and 14.5%; in patients with normal geometry, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy, respectively. Conclusions: The prevalence of AF increased in accordance with a larger mean left atrial diameter as per geometric remodeling patterns.

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A 75‐year‐old male presented with palpitation on exertion. He suffered from frequent tachycardia attacks. His 12‐leads electrocardiogram showed irregular cycle lengths (400–550 ms) of tachycardia with occasional 2:1 atrioventricular conduction (thus AV reentry was excluded). He had a complex anatomy of persistent left superior vena cava (PLSVC)/ enlarged coronary sinus (CS). The activation map in a 3‐dimensional CARTO system (Biosense‐Webster, USA) was merged with the multi‐detector computed tomography image and revealed that the tachycardia spread centrifugally from the junction between the PLSVC and enlarged CS. However, delivery of radio frequency (RF) energy to the earliest atrial activation site did not affect the tachycardia. Finally, the tachycardia was diagnosed as a fast/ slow type atrioventricular nodal reentrant tachycardia (AVNRT) because the tachycardia was cured only after the anterograde/retrograde AV conduction was disturbed by the application of RF energy to the posteroseptal perimitral area, possibly due to the injury to the AV node.

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