Determinants of Left Atrial Volume in Patients with Atrial Fibrillation

INTRODUCTION: Left atrial (LA) enlargement is an important risk factor for incident stroke and a key determinant for the success of rhythm control strategies in patients with atrial fibrillation (AF). However, factors associated with LA volume in AF patients remain poorly understood. METHODS: Patients with paroxysmal or persistent AF were enrolled in this study. Real time 3-D echocardiography was performed in all participants and analyzed offline in a standardized manner. We performed stepwise backward linear regression analyses using a broad set of clinical parameters to determine independent correlates for 3-D LA volume. RESULTS: We included 210 patients (70.9% male, mean age 61+/-11years). Paroxysmal and persistent AF were present in 95 (45%) and 115 (55%) patients, respectively. Overall, 115 (55%) had hypertension, 11 (5%) had diabetes, and 18 (9%) had ischemic heart disease. Mean indexed LA volume was 36+/-12ml/m2. In multivariable models, significant associations were found for female sex (beta coefficient -10.51 (95% confidence interval (CI) -17.85;-3.16), p = 0.0053), undergoing cardioversion (beta 11.95 (CI 5.15; 18.74), p = 0.0006), diabetes (beta 14.23 (CI 2.36; 26.10), p = 0.019), body surface area (BSA) (beta 34.21 (CI 19.30; 49.12), p>0.0001), glomerular filtration rate (beta -0.21 (CI -0.36; -0.06), p = 0.0064) and plasma levels of NT-pro brain natriuretic peptide (NT-proBNP) (beta 6.79 (CI 4.05; 9.52), p>0.0001), but not age (p = 0.59) or hypertension (p = 0.42). Our final model explained 52% of the LA volume variability. CONCLUSIONS: In patients with AF, the most important correlates with LA volume are sex, BSA, diabetes, renal function and NT-proBNP, but not age or hypertension. These results may help to refine rhythm control strategies in AF patients.