Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study.

Vaziri, Sonya M.; Larson, Martin G.; Benjamin, Emelia J.; Levy, Daniel

doi:10.1161/01.cir.89.2.724

Cited by 955 publications

(684 citation statements)

References 35 publications

Supporting

Mentioning

623

Contrasting

Unclassified

Order By: Relevance

“…Some studies have shown that BMI is one of the most powerful determinants of left atrial size. 18,19 In obese patients, left atrial enlargement and electrical instability may be caused by elevated plasma volume, ventricular diastolic dysfunction and enhanced neurohormonal activity. It has been previously reported that changes in left atrial dimension and pressure may influence P-wave duration.…”

Section: P-wave Duration and Dispersionmentioning

confidence: 99%

Effect of obesity on P-wave dispersion and QT dispersion in women

et al. 2006

View full text Add to dashboard Cite

Objective: The aim of this study was to investigate the effect of obesity on dispersion of P-wave duration and QTc interval in obese women. Methods: Forty-two obese women (Body mass index (BMI) ¼ 4073 kg/m 2 , mean age 4579 years) and compared agematched (BMI ¼ 2271 kg/m 2 , mean age 4176 years) twenty-five non-obese women were included in our study. Maximum and minimum P-wave duration, P-wave dispersion (difference between the maximum and the minimum P-wave duration), maximum and minimum QTc interval, and QTc dispersion (the difference between the maximum and the minimum QTc interval) were measured from 12-lead ECG. ECG's were transferred to a personal computer via a scanner and then used for magnification of 400 times by Adobe Photoshop software. Results: There was significant difference in BMI (4073 vs 2271 kg/m 2 , Po0.001, respectively) between obese and non-obese women. Obese women had higher Max. P-wave duration (116711 vs 94714 ms, Po0.001), P-wave dispersion (51715 vs 26711 ms, Po0.001), Max. QTc interval (449738 vs 419730 ms, Po0.001) and QTc dispersion (57723 vs 38715 ms, Po0.001) compared to non-obese women. A significant correlation was found between BMI and Max. P-wave duration (r ¼ 0.584, Po0.001), P-wave dispersion (r ¼ 0.621, Po0.001), Max. QTc interval (r ¼ 0.410, Po0.001), and QTc dispersion (r ¼ 0.429, Po0.001). In the linear regression analysis, compared to co-morbidity factors such as age, hypertension, diabetes mellitus and smoking, there was significant association between only BMI and electrocardiographic values (P-wave and QTc dispersion). Conclusion: We concluded that obesity caused significant increase in P-wave and QTc dispersion. Therefore, obese women may not only be under the risk of ventricular arrhythmias, but also they may under the risk of atrial arrhythmias.

show abstract

Section: P-wave Duration and Dispersionmentioning

confidence: 99%

Effect of obesity on P-wave dispersion and QT dispersion in women

et al. 2006

View full text Add to dashboard Cite

show abstract

“…stunning; remodeling; atrial tachyarrhythmias A RELATIONSHIP between atrial size and atrial fibrillation (AF) was first proposed by Fraser and Turner in 1955 (1), who showed that AF was more common in patients with enlarged atria than in patients with normal atrial size. In the 1990s, large prospective trials established left atrial enlargement as an independent risk factor for the development of AF (13,14). Today, it is generally accepted that AF is not only a consequence but also a cause of atrial dilatation.…”

mentioning

confidence: 99%

Loss of atrial contractility is primary cause of atrial dilatation during first days of atrial fibrillation

Schotten¹,

Haan²,

Neuberger³

et al. 2004

American Journal of Physiology-Heart and Circulatory Physiology

View full text Add to dashboard Cite

Allessie. Loss of atrial contractility is primary cause of atrial dilatation during first days of atrial fibrillation. Am J Physiol Heart Circ Physiol 287: H2324 -H2331, 2004. First published July 15, 2004 doi: 10.1152/ajpheart.00581.2004.-Atrial fibrillation (AF) induces a progressive dilatation of the atria which in turn might promote the arrhythmia. The mechanism of atrial dilatation during AF is not known. To test the hypothesis that loss of atrial contractile function is a primary cause of atrial dilatation during the first days of AF, eight goats were chronically instrumented with epicardial electrodes, a pressure transducer in the right atrium, and piezoelectric crystals to measure right atrial diameter. AF was induced with the use of repetitive burst pacing. Atrial contractility was assessed during sinus rhythm, atrial pacing (160-, 300-, and 400-ms cycle length), and electrically induced AF. The compliance of the fibrillating right atrium was measured during unloading the atria with diuretics and loading with 1 liter of saline. All measurements were repeated after 6, 12, and 24 h of AF and then once a day during the first 5 days of AF. Recovery of the observed changes after spontaneous cardioversion was also studied. After 5 days of AF, atrial contractility during sinus rhythm or slow atrial pacing was greatly reduced. During rapid pacing (160 ms) or AF, the amplitude of the atrial pressure waves had declined to 20% of control. The compliance of the fibrillating atria increased twofold, whereas the right atrial pressure was unchanged. As a result, the mean right atrial diameter increased by ϳ12%. All changes were reversible within 3 days of sinus rhythm. We conclude that atrial dilatation during the first days of AF is due to an increase in atrial compliance caused by loss of atrial contractility during AF. Atrial compliance and size are restored when atrial contractility recovers after cardioversion of AF. stunning; remodeling; atrial tachyarrhythmias A RELATIONSHIP between atrial size and atrial fibrillation (AF) was first proposed by Fraser and Turner in 1955 (1), who showed that AF was more common in patients with enlarged atria than in patients with normal atrial size. In the 1990s, large prospective trials established left atrial enlargement as an independent risk factor for the development of AF (13,14). Today, it is generally accepted that AF is not only a consequence but also a cause of atrial dilatation. In patients with "lone AF," Sanfilippo et al. (9) demonstrated that AF resulted in progressive atrial dilatation, which in turn, might contribute to the self-perpetuating nature of the arrhythmia.The mechanism of atrial dilatation related to AF is still unclear. It has been proposed that mild impairment of ventricular pump function due to the high ventricular rate during AF might increase end-diastolic ventricular and atrial pressures (12). An alternative explanation might be that the pronounced atrial contractile dysfunction of the atria induced by AF (6, 7, 10) underlies the dilatation of ...

show abstract

“…Large population-based studies have established atrial dilation as an independent risk factor for the development of AF. 17,18 An increase in atrial size increases the possible number of multiple wavelets during AF. Perpetuation of AF is promoted by an atrial substrate that favors initiation and continuation of reentering wavelets.…”

Section: Discussionmentioning

confidence: 99%

Atrial Electroanatomical Remodeling as a Determinant of Different Outcomes Between Two Current Ablation Strategies: Circumferential Pulmonary Vein Isolation Vs Pulmonary Vein Isolation

Hwang

Lee

Joung

et al. 2010

Clinical Cardiology

View full text Add to dashboard Cite

Background: The purpose of this study was to investigate the relationship between the efficacy of the 2 different ablation techniques of atrial fibrillation (AF) and left atrial (LA) size. Methods and Results: A total of 81 patients with paroxysmal AF (n = 58) or persistent AF (n = 23) refractory to antiarrhythmic drugs underwent circumferential pulmonary vein isolation (PVI; n = 45) or PVI (n = 36) without respect to echocardiographic results for LA volume index (LAVI). Of the 81 patients, 41 had less dilated LA (group 1; LAVI <27 cc/m 2 ) and 40 had dilated LA (group 2; LAVI ≥27 cc/m 2 ). During the 9-month follow-up, 33 patients (73.3%) after circumferential PVI and 18 (50%) after PVI (P = .031) were free of arrhythmia. The risk of recurrence was associated with persistent AF, hypertension, LAVI>27 ml/m 2 , PVI, early recurrence of AF, and lower left ventricular (LV) ejection fraction (all P value <.05). In the univariate analysis of each group, PVI (hazard ratio [HR]: 2.92, 95% confidence interval [CI]: 0.12-7.08, P = .018) was associated with late recurrence only in group 2. Cox regression analysis also showed that PVI (HR: 5.6, 95% CI: 1.9-16.56, P = .002) was a significant independent predictor of recurrence only in group 2. Conclusions: Circumferential PVI is more effective than PVI only in patients with a structural change of the atria, that is, a dilated LA. Our study suggests that a successful outcome in dilated LA may depend on wide modification of LA electroanatomical substrates, but wide ablation in less dilated LA may be unnecessary. Different technical strategies according to LA size are required for more a effective outcome.

show abstract

Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study.

Cited by 955 publications

References 35 publications

Effect of obesity on P-wave dispersion and QT dispersion in women

Effect of obesity on P-wave dispersion and QT dispersion in women

Loss of atrial contractility is primary cause of atrial dilatation during first days of atrial fibrillation

Atrial Electroanatomical Remodeling as a Determinant of Different Outcomes Between Two Current Ablation Strategies: Circumferential Pulmonary Vein Isolation Vs Pulmonary Vein Isolation

Contact Info

Product

Resources

About