Changes in left atrial size in patients with persistent atrial fibrillation: a prospective echocardiographic study with a 5-year follow-up period.
ABSTRACT Atrial fibrillation (AF) is a common arrhythmia, occurring in 0.4% of the general population. AF has been shown to be associated with left atrial enlargement, which is considered both a cause and a consequence of the arrhythmia. The aim of the study was to determine the influence of AF on changes in echocardiographically determined left atrial (LA) size, during 5 year follow-up period, in a population with well-controlled hypertension, free from structural heart disease, except mild left ventricle thickening, and with an absence of other potential causes of atrial enlargement. The study group, comprised of 81 patients with persistent AF, with underlying hypertensive heart disease, consecutively referred for elective direct current cardioversion. The mean age of the study population was 59.3+/-8.4 years (ranged from 43 to 80), a mean AF duration was 8.8+/-8.7 months (ranged from 1 to 30 months). The patients underwent two-dimensional echocardiography to determine left atrial size, before and 5 years after cardioversion. Twenty out of eighty-one cardioverted patients maintained sinus rhythm 5 years after cardioversion (25%). In this group anteroposterior LA dimension and LA volume decreased from a mean (+/-S.D.) 49.7+/-4.5 to 46.8+/-4.8 mm (-6%, p < 0.05) and from 103.6+/-28.8 to 91.1+/-18.3 cm2 (-9.2%, p < 0.05), respectively. Left ventricle ejection fraction increased from 52.8+/-6.3% to 60.0+/-4.0% (p < 0.05) and clinical stage improved in patients who maintained sinus rhythm through 5 years. In contrast, in the AF group, anteroposterior LA dimension and LA volume increased from 46.6+/-4.3 to 48.1+/-5.6 mm, and from 91.3+/-20 to 103+/-34 cm2 (by an average 3.3% and 14.3%, respectively), at the end of study. When divided into two groups: Imid R:II and III NYHA class, in AF patients LA volume increased by an 21.4% in the III NYHA class and 7.3% in the Imid R:II NYHA class. Left ventricular ejection fraction did not change between the two echocardiographic studies in the AF group (44.9+/-14.3% vs. 44.6+/-12.9%, Ns). In conclusion, it has been proved that AF occurring in patients with hypertensive heart disease causes a slow and progressive increase in LA size especially in patients in functional III NYHA class, and that the maintenance of sinus rhythm partially reverts the process of LA enlargement in patients with well-controlled hypertension, a history of AF and successfully treated for AF.
Article: Cardioversión eléctrica transtorácica de la fibrilación auricular persistente: un dilema persistenteRevista Argentina de Cardiología. 01/2005;
Article: THE SIZE OF THE LEFT ATRIUM IN PATIENTS WITH PAROXYSMAL ATRIAL FIBRILLATION AND ARTERIAL HYPERTENSION[show abstract] [hide abstract]
ABSTRACT: Atrial fibrillation is common supraventricular arrhythmia associated with arterial hypertension. The mechanisms that affect arterial hypertension causing atrial fibrillation are various and include: left ventricle hypertrophy, myocardial ischemia, left ventricle impaired function and left atrium enlargement.The aim of the study was to determine the size of the left atrium in paroxysmal atrial fibrillation and arterial hypertension patients.The investigation comprised a group of 117 paroxysmal atrial fibrillation patients. Of this number, 87 patients had arterial hypertension, and 30 patients were without arterial hypertension and other disorders and diseases (LONE).The arterial hypertension patients were divided into 3 groups: the arterial hypertension patients, those without left ventricle hypertrophy and without ischemia; the arterial hypertension patients, those with left ventricle hypertrophy but without ischemia and the arterial hypertension patients with concomitant ischemic heart disease. The patients without arterial hypertension and other disorders and diseases (LONE) represented the fourth group.The size of the left atrium was recorded by echocardiography. The highest average left atrium size value was found in the arterial hypertension patients, those with concomitant ischemic heart disease and it was 43,39 mm; in the arterial hypertension patients with left ventricle hypertrophy but without ischemia, it amounted to 39,85 mm. The average left atrium size value in arterial hypertension patients, those without left ventricle hypertrophy and without ischemia was 37,24 mm, and the lowest average left atrium size value was in the patients without arterial hypertension (LONE) and it was 34,61 mm.On this number, 80.95% of arterial hypertension patients, those with concomitant ischemic heart disease as well as 45.45% of arterial hypertension patients with left ventricle hypertrophy and without ischemia had the enlarged left atrium. The patients without arterial hypertension (LONE) did not have the enlarged left atrium.It may be concluded that the left atrium size in the arterial hypertension patients in the presence of left ventricle hypertrophy, and especially with the concomitant ischemic heart disease, represents a significant prerequisite for paroxysmal atrial fibrillation genesis. The highest percentage of the patients with enlarged left atrium in the group with arterial hypertension and concomitant ischemic heart disease proves that the ischemic heart disease is the most common arrhythmic factor. The left ventricle hypertrophy immediately follows the ischemic heart disease.Acta Medica Medianae. 01/2008;