The left atrium, atrial fibrillation, and the risk of stroke in hypertensive patients with left ventricular hypertrophy

Abstract

Abstract:The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study provided extensive data on predisposing factors, consequences, and prevention of atrial fibrillation (AF) in patients with hypertension and left ventricular (LV) hypertrophy. Randomized losartan-based treatment was superior to atenolol-based treatment for reducing new-onset AF and complications, especially stroke, associated with new-onset or pre-existing AF. Potential mechanisms of AF prevention by angiotensin receptor blockade supported by LIFE results include greater reduction in left atrial size and LV hypertrophy. Differential effects of antihypertensive treatment on the left atrium and left ventricle may help prevent AF and reduce risk of stroke associated with hypertensive heart disease.

Relationship of left atrial enlargement to persistence or development of ECG left ventricular hypertrophy in hypertensive patients: implications for the development of new atrial fibrillation

“…Because these analyses were performed in hypertensive patients with ECG LVH on a screening ECG [27], these findings may not be generalizable to other patient groups. Finally, exclusion of patients with atrial fibrillation by history or on their baseline ECG may have weakened the associations between changing ECG LVH and left atrial dimension and enlargement, given the greater left atrial size in patients with atrial fibrillation [2][3][4][5][6][7][8].…”

“…It is interesting to speculate whether atrial fibrosis [2,24,36] and electrical remodeling of the left atrial involving changes in ion channel function or expression that are associated with increases in left atrial pressure and size [2,36] may play a role in facilitating the initiation and maintenance of atrial fibrillation and provide a putative causal relationship between LAE and its associated risk of atrial fibrillation [2][3][4][5][6][7][8]. However, further study will be required to evaluate whether changes in left atrial fibrosis, electrophysiology or both in response to changes in left atrial size are directly related to atrial fibrillation risk and chronicity.…”

“…Left atrial enlargement (LAE) is a common finding in hypertensive patients [1] and is associated with an increased risk of atrial fibrillation [2][3][4][5][6][7][8] and stroke [8][9][10] in a variety of populations. However, a causal relationship between left atrial structural remodeling and atrial fibrillation has been difficult to establish [7,11].…”

Statin prescribing among hypertensive patients in southwest Nigeria: findings and implications for the future

“…It is a risk factor for development of cardiovascular diseases, which is a leading cause of morbidity and mortality worldwide [4]. The presence of elevated total and low density lipoprotein in hypertensive patients further increases cardiovascular risk [5].…”

Atrial interaction in the form of ‘cross talk’ in patients with ventricular outflow tract obstruction

“…Atrial interaction is underminded in clinical practice although it is well recognised that atrial disease and arrhythmia are closely related to each other in patients with ventricular hypertrophy [6]. Determining the presence of atrial interaction should provide clinical insight into the development of atrial arrhythmia in these patients.…”