Left atrial appendage anatomy and function: short term response to sustained atrial fibrillation
M J Weigner, S E Katz, P S Douglas, W J Manning
Department of
Medicine (Cardiovascular Division) and the Harvard-Thorndike Laboratory
of Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston,
MA 02215, USA
Correspondence to: Dr Manning. email: wmanning{at}caregroup.harvard.edu
Accepted for publication 4 January 1999
OBJECTIVE
To determine
whether there is significant atrial or atrial appendage enlargement or
functional remodelling as a result of one to two months of sustained
atrial fibrillation, a duration similar to that experienced by patients
undergoing warfarin anticoagulation before elective cardioversion.
METHODSTo test the
hypothesis that left atrial and left atrial appendage enlargement
develop as a result of short term atrial fibrillation, serial
anatomical and functional indices were measured using transoesophageal echocardiography (TOE) in 20 patients with recent onset atrial fibrillation (14 men, six women; mean (SEM) age 67 (2) years). Serial
TOE was performed 2.5 months apart in patients with sustained atrial fibrillation.
RESULTSThere was no
significant change in left atrial area (23.7 cm2 to 24.1 cm2, p = 0.98); length (5.7 cm to 5.7 cm, p = 0.48);
width (5.2 cm to 5.2 cm, p = 0.65); volume (83 cm3 to 87 cm3, p = 0.51) or left atrial appendage area (7.9 cm2 to 8.1 cm2, p = 0.89); length (4.6 cm to
4.5 cm, p = 0.8); or width (2.5 to 2.4 cm, p = 0.87). Peak left
atrial appendage velocity ejection (0.2 m/s to 0.2 m/s, p = 0.57),
and presence of severe spontaneous echo contrast in the left atrial
appendage (n = 15 (75%) to n = 13 (72%)) were also not
significantly different. There was no correlation between changes in
left atrial or left atrial appendage dimensions.
CONCLUSIONSIn the
setting of sustained atrial fibrillation, significant left atrial and
left atrial appendage functional and anatomical remodelling do not
occur with atrial fibrillation of a duration similar to that used for
conservative anticoagulation in preparation for cardioversion.
Keywords: atrial fibrillation; left atrial appendage; remodelling
© 1999 by Heart
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