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Heartbeat: is the keyword ‘atrial’ or ‘fibrillation’?
  1. Catherine M Otto
  1. Division of Cardiology, University of Washington, Seattle, WA 98195, USA
  1. Correspondence to Professor Catherine M Otto, Division of Cardiology, University of Washington, Seattle, WA 98195, USA; cmotto{at}uw.edu

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The association of left atrial (LA) enlargement, atrial fibrillation (AF) and adverse cardiovascular outcomes is well known. However, it remains unclear whether this association is simply related to AF or whether LA size also is an important prognostic variable. In a meta-analysis of over 50 000 patients from studies that included patients with (n=23) or without (n=68) AF, Froehlich and colleagues1 found stronger associations between LA size and cardiovascular outcomes in patients without compared with those with AF (figure 1). For example, a larger LA diameter was significantly associated with stroke and thromboembolic events (risk ratio (RR) 1.38, 95% CI 1.02 to 1.87; p=0.03) in patients without AF, but not in those with AF (RR 1.02, 95% CI 0.98 to 1.07; p=0.27; p for difference=0.05). The authors propose that these associations likely are due to LA size reflecting atrial myopathy even when AF is not present.

Figure 1

Association of LA diameter index and risk of cardiovascular outcomes. Association of LA diameter index with incident stroke or thromboembolic events (A) and major adverse cardiac events (B). Data are risk ratios with corresponding 95% CIs from inverse variance (IV)-weighted random-effects models. Meta-analysis results are separately presented as diamonds for studies including patients with AF and studies without patients with AF. AF, atrial fibrillation; LA, left atrial.

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