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Left atrial appendage anatomy and function: short term response to sustained atrial fibrillation
M J Weigner1, S E Katz, P S Douglas
1Department of Medicine (Cardiovascular Division) and the Harvard-Thorndike Laboratory of Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
Objective:
To determine whether there is significant atrial or atrial appendage enlargement or functional remodelling as a result of one to two months of sustained atrial fibrillation, a duration similar to that experienced by patients undergoing warfarin anticoagulation before elective cardioversion.
Methods:
To test the hypothesis that left atrial and left atrial appendage enlargement develop as a result of short term atrial fibrillation, serial anatomical and functional indices were measured using transoesophageal echocardiography (TOE) in 20 patients with recent onset atrial fibrillation (14 men, six women; mean (SEM) age 67 (2) years). Serial TOE was performed 2.5 months apart in patients with sustained atrial fibrillation.
Results:
There was no significant change in left atrial area (23.7 cm(2) to 24.1 cm(2), p = 0.98); length (5.7 cm to 5.7 cm, p = 0.48); width (5.2 cm to 5.2 cm, p = 0. 65); volume (83 cm(3) to 87 cm(3), p = 0.51) or left atrial appendage area (7.9 cm(2) to 8.1 cm(2), p = 0.89); length (4.6 cm to 4.5 cm, p = 0.8); or width (2.5 to 2.4 cm, p = 0.87). Peak left atrial appendage velocity ejection (0.2 m/s to 0.2 m/s, p = 0.57), and presence of severe spontaneous echo contrast in the left atrial appendage (n = 15 (75%) to n = 13 (72%)) were also not significantly different. There was no correlation between changes in left atrial or left atrial appendage dimensions.
Conclusions:
In the setting of sustained atrial fibrillation, significant left atrial and left atrial appendage functional and anatomical remodelling do not occur with atrial fibrillation of a duration similar to that used for conservative anticoagulation in preparation for cardioversion.