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Updated: Dec 12, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Left atrial structure and function among different subtypes of atrial fibrillation: an echocardiographic substudy of
Flemming Javier Olsen1, Stine Darkner2, Xu Chen2
1Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark.
Insights
Persistent atrial fibrillation (AF) and high AF burden significantly impair left atrial (LA) function and structure. These findings highlight differences in cardiac mechanics across AF subtypes and burden.
Area of Science:
- Cardiology
- Cardiac Imaging
- Electrophysiology
Background:
- Atrial fibrillation (AF) is a common arrhythmia with varying subtypes, including paroxysmal AF (PxAF) and persistent AF (PxAF).
- Understanding the impact of AF subtypes and burden on cardiac structure and function, particularly left atrial (LA) mechanics, is crucial for patient management.
Purpose of the Study:
- To investigate differences in left atrial (LA) structure and function between paroxysmal AF (PxAF) and persistent AF (PxAF).
- To assess the impact of AF burden (0%, 0-99%, and 99-100%) on LA measures.
Main Methods:
- A cross-sectional echocardiographic substudy of 212 AF patients scheduled for catheter ablation.
- Conventional echocardiography and LA/LV speckle tracking were performed.
- Comparison of LA measures based on AF subtype (PxAF vs. PxAF) and AF burden (0%, 0-99%, 99-100%) determined by 72-h Holter monitoring.
Main Results:
- Patients with PxAF exhibited significantly reduced left ventricular ejection fraction, larger LA volumes (LAVi, LAEDVi), and impaired LA function (LAEF, LAs) compared to PxAF.
- Significantly reduced LA measures and systolic function were observed in patients with 99-100% AF burden.
- No significant differences in LA measures were found between 0% and 0-99% AF burden groups.
Conclusions:
- Left atrial (LA) mechanics are significantly different between atrial fibrillation (AF) subtypes and across varying AF burdens.
- These distinct LA characteristics necessitate careful consideration for accurate clinical interpretation of echocardiographic findings in AF patients.
Aims:
Little is known about cardiac structure and function among atrial fibrillation (AF) subtypes; paroxysmal AF vs. persistent AF (PxAF), and across AF burden. We sought to assess differences in left atrial (LA) measures by AF subtype and burden.
Methods And Results:
This was a cross-sectional echocardiographic substudy of a randomized trial of AF patients scheduled for catheter ablation. Patients had an echocardiogram performed 0-90 days prior to study inclusion. We performed conventional echocardiographic measures, left ventricular (LV) and LA speckle tracking. Measures were compared between AF subtype and burden (0%, 0-99%, and 99-100%) determined by 72-h Holter monitoring. Of 212 patients, 107 had paroxysmal AF and 105 had PxAF. Those with PxAF had significantly reduced systolic function (LV ejection fraction: 48% vs. 53%; P < 0.001), larger end-systolic and end-diastolic LA volumes (LAVi and LAEDVi), reduced LA emptying fraction (LAEF: 29% vs. 36%, P < 0.001), and reduced LA strain (LAs) (LAs: 20% vs. 26%, P < 0.001). LA measures remained significantly lower in PxAF after multivariable adjustments. All LA measures and measures of systolic function were significantly impaired in patients with 99-100% AF burden, whereas all measures were similar between the other groups (LAVi: 40mL/m2 vs. 33mL/m2 vs. 34mL/m2; LAEDVi: 31mL/m2 vs. 21mL/m2 vs. 22mL/m2, LA emptying fraction: 23% vs. 35% vs. 36%, LAs: 16% vs. 25% vs. 25%, for 99-100%, 0-99%, and 0% AF, respectively, P < 0.001 for all). These differences were consistent after multivariable adjustments.
Conclusion:
LA mechanics differ between AF subtype and burden and these characteristics influence the clinical interpretation of these measures.
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