Permanent atrial fibrillation is associated with worse echocardiographic parameters and an unfavorable prognosis

Abstract

Introduction: Atrial fi brillation is the main etiological factor leading to the development of atrial cardiomyopathy (ACM). The different types of atrial fi brillation (AF) are characterized by varying severity of atrial dysfunction, symptoms, and prognosis. Objective: The aim of our study is to analyze the echocardiographic parameters of patients with atrial cardiomyopathy with paroxysmal and permanent atrial fi brillation and to investigate the prognosis of these patients. Material and Methods: We studied 180 consecutive patients with advanced atrial cardiomyopathy, defi ned as a severely dilated left atrium with indexed volume (LAVI) ≥ 48 ml/m², preserved left ventricular ejection fraction (LVEF > 50%), without the presence of primary valvular diseases or ventricular dysfunction. We divided patients with ACM into two groups depending on whether they were with paroxysmal AF (n = 88) or with permanent AF (n = 92). All patients underwent detailed echocardiography with volumetric and speckle tracking analysis at inclusion. Results: The mean age of patients with ACM was 74.1 ± 8.7 years, with 58% being women. The ejection fraction and global longitudinal strain of the left ventricle in patients with permanent AF were signifi cantly lower than those in patients with paroxysmal AF. This was also true for the left atrial reservoir strain (LASr: 10.2 ± 4.6% vs. 23.7 ± 7.9%, p < 0.001). Similar fi ndings were observed in the volume of the right atrium, right ventricular function parameters, and right atrial reservoir strain (RASr: 12.1 ± 6.9% vs. 24.4 ± 8.0%, p < 0.001). Patients with permanent AF also showed a signifi cantly higher grade of tricuspid regurgitation. Over a mean follow-up of 19 months, the mortality rate was signifi cantly higher in the permanent AF group at 20%, compared to 8% in the paroxysmal AF group (p = 0.03). Conclusion: Patients with atrial cardiomyopathy and permanent atrial fi brillation exhibit signifi cantly worse echocardiographic parameters, including those of the right heart chambers, and have a poorer prognosis compared to those with paroxysmal atrial fi brillation.

Keywords

• atrial cardiomyopathy
• permanent atrial fibrillatio