A1 Refereed original research article in a scientific journal
Effect of Bi-Atrial Size and Function in Patients With Paroxysmal or Permanent Atrial Fibrillation
Authors: Bax Maxim, Marsan Nina Ajmone, Delgado Victoria, Bax Jeroen J, van der Bijl Pieter
Publisher: Elsevier
Publication year: 2022
Journal: American Journal of Cardiology
Journal name in source: The American journal of cardiology
Journal acronym: Am J Cardiol
ISSN: 0002-9149
eISSN: 1879-1913
DOI: https://doi.org/10.1016/j.amjcard.2022.07.024
Web address : https://www.sciencedirect.com/science/article/pii/S0002914922008311?via%3Dihub
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/176521879
Atrial fibrillation (AF) remains the most common arrhythmia in clinical practice. The choice between a rate-control and rhythm-control strategy depends on various factors, including the anatomical and functional substrate. This study investigates the anatomical and functional characteristics of both atria in patients with AF and explores the potential therapeutic implications. From an ongoing registry of patients with paroxysmal or permanent AF, those who underwent cardiac computed tomography (CCT) were included. Left atrial (LA) and right atrial (RA) sizes were measured on CCT, whereas bi-atrial function was quantified with speckle tracking strain echocardiography. The mean LA volume index was 41.6 ± 5.6 ml/m2, and the mean RA volume index was 71.0 ± 21.6 ml/m2. Mean LA reservoir strain was 24.3 ± 15.1%, compared with the mean RA reservoir strain of 21.6 ± 13.2%. Patients with smaller LA volumes had higher LA reservoir strain values than those with larger LA volumes (24.6% [interquartile range (IQR) 15.8 to 35.8] vs 16.5% [IQR 11.2 to 25.0], p <0.001). Patients with permanent AF had larger LA volumes (44.0 [IQR 33.7 to 55.2] ml/m2 vs 36.9 [IQR 30.1 to 47.1] ml/m2, p = 0.025) compared with paroxysmal AF. Patients with permanent AF had more impaired LA reservoir strain (15.5% [IQR 11.6 to 22.7] vs 26.9% [IQR 17.4 to 35.6], p <0.001) compared with paroxysmal AF. Similar trends were observed in the RA. In conclusion, atrial substrate characterization by CCT and speckle tracking strain echocardiography may have therapeutic implications, especially for choosing between a rate-control and rhythm-control strategy.
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