Right Atrial Size and Function to predict Left Atrial Voltage Defined
Fibrosis in Patients with Long-standing Persistent Atrial Fibrillation
Abstract
Background: Right atrial (RA) size and function are not well described
in long-standing persistent AF (LSPAF) patients, nor their value as a
predictor for the left atrial (LA) voltage-defined fibrosis. Methods: An
evaluation was made as to whether echocardiography determined RA length,
planimetered area, volume, emptying fraction, stroke volume, expansion
index and calculated derivates among the LSPSAF population predict LA
low voltage areas (LVA) acquired with high-density and high-resolution
bipolar voltage mapping using the CARTO®3 system. Results: 142 patients
aged 63 (58-67) years old, 117 males, were enrolled in our study. LVA
were detected in 54% of the patients.Severe global LVA burden was
present in 15% of the patients, whereas 30% of the patients presented
a disseminated pattern of remodelling. We have shown that (1) the
majority of the study population (76%) presented enlarged RA, however
RA volumes were larger than LA volumes in the minority of cases (2) RA
enlargement had a positive correlation with the presence of
mild-to-moderate tricuspid regurgitation, left ventricular hypertrophy,
LA enlargement, LA area and volume (3), none of the RA indices were
associated with the prediction of absolute LVA or advanced LA fibrotic
remodelling, although patients with severe LVA burden presented longer
RA length and a larger area than comparing to patients with less
advanced remodelling pattern. Conclusions: It was found that RA
enlargement and decreased RA function, common in LSPSAF patients, do not
translate to the presence of voltage-derived LA fibrotic remodelling