Circulation, Vol 53, 273-279, Copyright © 1976 by American Heart Association
WL Henry, J Morganroth, AS Pearlman, CE Clark, DR Redwood, SB Itscoitz and SE Epstein
In an attempt to define quantitatively the relation between left atrial
size and atrial fibrillation, echocardiography was used to study 85
patients with isolated mitral valve disease, 50 patients with isolated
aortic valve disease, and 130 patients with asymmetric septal hypertrophy.
In all three groups of patients, atrial fibrillation was rare when left
atrial dimension was below 44 mm (3 of 117 or 3%) but common when this
dimension exceeded 40 mm (80 of 148 or 54%). In addition, when left atrial
dimension exceeds 45 mm, cardioversion, while initially successful, is
unlikely to produce sinus rhythm that can be maintained at least six
months. These data suggest that left atrial size is an important factor in
the development of atrial fibrillation and in determining the long term
result of cardioversion. The pathophysiologic mechansim most consistent
with this is that a chronic hemodynamic burden initially produces left
atrial enlargement which in turn predisposes to atrial fibrillation. Only
prospective studies will determine definitively whether these observations
will be useful in decisions concerning prophylactic anticoagulation and
elective cardioversion.
ARTICLES
Relation between echocardiographically determined left atrial size and atrial fibrillation
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