Natural history of echocardiographic changes in atrial fibrillation: A case-controlled study of longitudinal remodeling

[www.heartrhythmjournal.com]

“Conclusion

AF is associated with higher rates of left atrial enlargement, LV systolic and diastolic dysfunction, and mitral regurgitation that typically manifest within 6–24 months of diagnosis. The natural history of cardiac remodeling in patients with AF may inform treatment decisions and facilitate patient-tailored care.“

This has been my understanding all along, but it's nice to see confirmation every once in a while. Thanks, Susan.

I don't have access to the full file, just the summary. I'm curious if these results are irrespective of someone who had AF at some point but remains in NSR (through whatever means such as lifestyle, meds, ablation, etc.) as well as someone who is in AF fairly regularly but has good rate control.

Thanks

Quote
BobsBeat
I don't have access to the full file, just the summary. I'm curious if these results are irrespective of someone who had AF at some point but remains in NSR (through whatever means such as lifestyle, meds, ablation, etc.) as well as someone who is in AF fairly regularly but has good rate control.

Thanks

Abstract

Atrial fibrillation (AF) can be a cause and consequence of cardiac remodeling. The natural history of remodeling associated with AF is incompletely described.
Objective

The purpose of this study was to describe the frequency and timing of AF-associated echocardiographic changes.
Methods

Patients within the Duke University Health System with ≥2 transthoracic echocardiograms (TTEs) performed between 2005 and 2018 were evaluated. Patients with AF and normal baseline TTEs were matched to patients without AF on year of TTE, age, and CHA2DS2-VASc score. Frequency and timing of changes in chamber size, ventricular function, mitral regurgitation, and all-cause mortality were compared over 5 years of follow-up.
Results

The cohort included 3299 patients with AF at baseline and 7613 controls without AF. Normal baseline TTEs were acquired from 730 of patients with AF; 727 of these patients were matched to controls without AF. Patients with AF had higher rates of left atrial enlargement (hazard ratio

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1.53; 95% confidence interval 1.27–1.85; P < .001), left ventricular (LV) systolic dysfunction (HR 1.80; 95% confidence interval 1.00–3.26; P = .045), LV diastolic dysfunction (HR 1.51; 95% confidence interval 1.08–2.10; P = .01), and moderate or greater mitral regurgitation (HR 2.09; 95% confidence interval 1.27–3.43; P = .003) than did controls. Atrial enlargement, systolic dysfunction, and mitral regurgitation surpassed the rates seen in controls within 6–12 months, whereas differences in diastolic dysfunction emerged at 24 months. There were no differences in ventricular sizes or mortality.
Conclusion

AF is associated with higher rates of left atrial enlargement, LV systolic and diastolic dysfunction, and mitral regurgitation that typically manifest within 6–24 months of diagnosis. The natural history of cardiac remodeling in patients with AF may inform treatment decisions and facilitate patient-tailored care.

Yes I read the abstract, but for the Full Article you need to pay. Unless I missed it, the abstract did not spell out the burden of AF and their results.

That's why I asked "I'm curious if these results are irrespective of someone who had AF at some point but remains in NSR (through whatever means such as lifestyle, meds, ablation, etc.) as well as someone who is in AF fairly regularly but has good rate control."

Try requesting it from the author

[www.researchgate.net]

I actually have a subscription to heart rhythm journal (free-I said I’m a medical student-sort of true, I didn’t finish) so it allowed a download to the full article.

Sign up.

That was my question as well. There are some who are in flutter and never learn of it. Same for AF. This is important because unless there is very close monitoring of all of the cohort, who'd know what kind of AF we're dealing with, paroxysmal or persistent? I don't know that an AF patient who never does go into AF during the study still has an enlarged atrium due solely to the 'remodeling' that often precedes AF onset. It stands to reason that AF will cumulatively enlarge the atrium, but at what burden over how long?

What jumped out for me was the statement, 'There were no differences in ventricular sizes or mortality.' As Carey and others repeatedly tell us, AF won't really kill you. It's what comes of it that might.