Changes in left atrial size in patients with lone atrial fibrillation

Abstract

Summary: A retrospective analysis was performed on 23 subjects with lone atrial fibrillation who were followed for an average of 6.2 years (1.1 -12.8 years). In all patients, underlying organic heart disease was excluded based on history. physical exam, electrocardiogram, echocardiogram, and Doppler ultrasound interrogation. All patients had at least two echocardiographic studies during the period of observation. Atrial fibrillation was chronic in 1 I subjects and paroxysmal in 12. All echocardiographic measurements were obtained by averaging the measurements of two blinded investigators. Left atrial size increased an average of 5.6 mm which translates into a 14.7% increase over the baseline measurement. This increase in size was not associated with a change in left ventricular mass or fractional shortening as determined by echocardiography. Subjects with chronic atrial fibrillation had a larger percent increase lhan subjects with paroxysmal atrial fibrillation (18.9 vs. 10.8%)). although this relative change in size failed to reach statistical significance. The only variable which significantly contributed to the change in left atrial size was the duration of follow-up. We conclude that atrial fibrillation occurring in patients with lone atrial fibrillation may cause a slow and progressive increase in left atrial size independen@ of changes in left ventricular size or function.

Silent Atrial Fibrillation after Ischemic Stroke or Transient Ischemic Attack: Interest of Continuous ECG Monitoring

“…This supports the hypothesis that LA enlargement occurs only if AF becomes chronic [30,31]. Moreover, Suarez et al [32] reported that paroxysmal AF may induce slowly progressive LA enlargement. In addition, Kallmünzer et al [33] recently demonstrated that the risk of significant cardiac arrhythmia after an acute cerebrovascular event is highest during the first 24 h of care and then progressively declines over the first 3 days.…”

Left atrial volume is more important than the type of atrial fibrillation in predicting the long-term success of catheter ablation

“…These data suggest that, by valuing the type of AF over LA volume, we may be targeting patients who are in fact less likely to benefit from PV isolation than others in whom therapy is withheld due to efficacy concerns. Since LA dilatation tends to progress over time [36,37], our results also indirectly support earlier intervention in patients with symptomatic AF, backing the concept of a 'window of opportunity' for effective rhythm control therapy [1,38]. Finally, these results highlight the difficulties in predicting the long term outcome of PVI.…”

Changes in left atrial size in patients with persistent atrial fibrillation: a prospective echocardiographic study with a 5-year follow-up period

“…The role of the AF on changes in LA dimension was addressed in previous studies [5,16,17]. In heterogeneous cohorts, LA size was related to the duration of the arrhythmia and increased during a follow-up period.…”