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Changes in left atrial size in patients with lone atrial fibrillation
G S Suarez1, S Lampert, S Ravid
1Lown Cardiovascular Center, Department of Nutrition, Harvard School of Public Health, Brookline, MA 02146.
Insights
Lone atrial fibrillation may slowly enlarge the left atrium over time, independent of heart function. This study tracked 23 patients, finding a significant increase in left atrial size during follow-up.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Echocardiography
Background:
- Lone atrial fibrillation (AF) is diagnosed when AF occurs without underlying organic heart disease.
- The impact of lone AF on cardiac structure, particularly left atrial size, requires further elucidation.
- Longitudinal changes in left atrial dimensions in lone AF patients are not well-characterized.
Purpose of the Study:
- To investigate the changes in left atrial size over time in patients with lone atrial fibrillation.
- To determine if lone AF independently affects left atrial dimensions.
- To assess the relationship between AF type (chronic vs. paroxysmal) and left atrial remodeling.
Main Methods:
- Retrospective analysis of 23 patients diagnosed with lone atrial fibrillation.
- Exclusion of organic heart disease through comprehensive clinical evaluation and diagnostic tests.
- Serial echocardiographic assessments performed over an average follow-up of 6.2 years.
- Blinded, averaged measurements of left atrial size and left ventricular function parameters.
Main Results:
- A significant average increase of 5.6 mm (14.7%) in left atrial size was observed over the follow-up period.
- The increase in left atrial size was not associated with changes in left ventricular mass or fractional shortening.
- Duration of follow-up was the only significant predictor of left atrial size increase.
Conclusions:
- Atrial fibrillation in lone AF patients can lead to a slow, progressive increase in left atrial size.
- This atrial remodeling appears independent of left ventricular size or function.
- Further research is warranted to understand the long-term implications of this finding.
Abstract:
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 11 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 than 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 independent of changes in left ventricular size or function.