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Left atrial volume predicts cardiovascular events in patients originally diagnosed with lone atrial fibrillation: three-decade follow-up

Martin Osranek, Francesca Bursi, Kent R. Bailey, Brandon R. Grossardt, Robert D. Brown, Stephen L. Kopecky, Teresa S. Tsang, James B. Seward
DOI: http://dx.doi.org/10.1093/eurheartj/ehi483 2556-2561 First published online: 1 September 2005

Abstract

Aims The objectives of this study were to determine the long-term outcome and the predictors of adverse events in patients originally diagnosed with lone atrial fibrillation (AF).

Methods and results This population-based historical cohort study comprised 46 residents of Olmsted County, MN, USA, with well-documented, clinically defined lone AF and a complete two-dimensional echocardiographic examination. The original echocardiographic videotape recordings were analysed in a blinded fashion for left atrial volume (LAV) and left ventricular ejection fraction. With 1296 person-years of follow-up, the median duration of AF was 27 (first quartile=24, third quartile=33) years. Twenty-three (50%) patients developed events. Cerebral infarction occurred in seven patients, myocardial infarction in 11, and congestive heart failure in 16. In a multivariable analysis, patients with indexed LAV ≥32 mL/m2 had a significantly worse event-free survival (adjusted HR, 4.46; 95% CI, 1.56–12.74; P=0.005). All cerebral infarctions occurred in patients with an indexed LAV >32 mL/m2.

Conclusion Patients originally diagnosed with benign lone AF follow divergent courses based on LAV. Those originally diagnosed with lone AF and normal sized atria had a benign clinical course throughout the long-term follow-up. Patients with increased LAV at diagnosis or later during the follow-up experienced adverse events.

  • Lone atrial fibrillation
  • Left atrial volume
  • Echocardiography
  • Cerebral infarction
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