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Left Atrial Size and Left Atrial Volume Index as Predictors of Atrial High-Rate Episodes
Phuuwadith Wattanachayakul1,2, Thitiphan Srikulmontri1,2, Narathorn Kulthamrongsri3
1Department of Medicine, Jefferson Einstein Hospital, Philadelphia, Pennsylvania, USA.
Insights
Atrial high-rate episodes (AHRE) are linked to larger left atrial size. Patients with AHRE showed increased left atrial diameter and volume index, suggesting morphology impacts cardiac events.
Area of Science:
- Cardiology
- Echocardiography
- Electrophysiology
Background:
- Atrial high-rate episodes (AHRE) correlate with adverse cardiovascular outcomes, including stroke and mortality.
- Predictors for AHRE are sought, but the role of left atrial morphology is not well-defined.
Purpose of the Study:
- To investigate the association between left atrial morphology and the occurrence of AHRE.
- To determine if left atrial diameter and volume index predict AHRE in patients without prior atrial fibrillation.
Main Methods:
- Systematic review and meta-analysis of 18 cohort studies from MEDLINE and EMBASE.
- Left atrial morphology assessed by left atrial diameter (LAD) and left atrial volume index (LAVI) via echocardiography.
- Pooled mean differences calculated using the generic inverse variance method.
Main Results:
- Patients with AHRE exhibited significantly larger left atrial diameter (mean difference: 2.19 mm) and LAVI (mean difference: 4.88 mL/m²).
- Statistical significance was confirmed for both LAD and LAVI differences (p < 0.001).
- Heterogeneity was noted (I² = 80% for LAD, I² = 55% for LAVI).
Conclusions:
- Increased left atrial diameter and LAVI are associated with the presence of AHRE.
- Left atrial morphology may be a significant factor in the development of AHRE.
- Further research is warranted to elucidate the causal mechanisms.
Background:
Recent studies have shown that atrial high-rate episodes (AHREs) are associated with adverse cardiovascular outcomes, including an increased risk of stroke, cardiovascular mortality, and future atrial fibrillation. Despite efforts to identify predictors for AHRE, the relationship between left atrial morphology and AHRE remains unclear.
Methods:
We systematically reviewed MEDLINE and EMBASE from inception to May 2024 to assess the association between left atrial morphology, measured as left atrial diameter (mm) and left atrial volume index (LAVI, mL/m2) via transthoracic echocardiography, and the occurrence of AHRE in patients without a prior history of atrial fibrillation at device implantation. Means and standard deviations of LAD and LAVI were extracted to calculate pooled mean differences using the generic inverse variance method.
Results:
A total of 18 cohort studies were included in the meta-analysis. The results showed that patients with AHRE had significantly higher left atrial diameter and LAVI compared to those without AHRE. The pooled mean difference for left atrial diameter was 2.19 mm (95% CI: 1.11-3.28; I2 = 80%, p < 0.001), while for LAVI, it was 4.88 mL/m2 (95% CI: 2.55-7.21; I2 = 55%, p < 0.001).
Conclusions:
Our study demonstrated that patients with AHRE had greater left atrial diameter and LAVI than those without AHRE. Further research is needed to clarify the underlying mechanism.
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