Cited by 739Atrial Fibrillation Management and OutcomesCardiovascular Function and Risk FactorsCardiac Arrhythmias and Treatments

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Atrial enlargement as a consequence of atrial fibrillation. A prospective echocardiographic study.

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Sanfilippo, A J, Abascal, V M, Sheehan, M, Oertel, L B, Harrigan, P, Hughes, R A, Weyman, A E·1990·Circulation

DOI 10.1161/01.cir.82.3.792

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Abstract

To test the hypothesis that atrial enlargement can develop as a consequence of atrial fibrillation, left and right atrial dimensions were measured echocardiographically at two different time points in patients with atrial fibrillation. Patients were selected who initially had normal atrial sizes and who had no evidence of significant structural or functional cardiac abnormalities other than atrial fibrillation either by history or two-dimensional and Doppler echocardiography. Fifteen patients were studied (12 men and three women; mean age, 67.3 years). Average time between studies was 20.6 months. Three orthogonal left atrial dimensions and two right atrial dimensions were measured, and all were found to increase significantly between studies. Also, highly significant increases in calculated left atrial volume (from 45.2 to 64.1 cm3, p less than 0.001) and right atrial volume (from 49.2 to 66.2 cm3, p less than 0.001) were observed. The relative extents of left and right atrial volume increase did not differ, and left ventricular size did not change significantly between studies. These results indicate that atrial enlargement can occur as a consequence of atrial fibrillation. The maintenance of sinus rhythm, therefore, may prevent atrial enlargement and its adverse clinical effects.

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Method
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“(2) Atrial ejection force was evaluated using this equation: 0.”
Method
Impact of left atrial appendage occlusion device position on potential determinants of device-related thrombus: a patient-specific in silico study
Zhong, Z., Gao, Y., Kovács, S., et al. (2023) · Clinical Research in Cardiology · doi:10.1007/s00392-023-02228-x · Cited by 15
“Blood stasis, platelet adhesion, as well as endothelial cell damage and dysfunction are promoted in the case of AF [12, 13], these factors may play an important role in thrombus formation after LAAO.”
Background
Echocardiographic and Hemodynamic Findings in Patients With Mitral Stenosis Undergoing Percutaneous Mitral Commissurotomy Comparing Those With Chronic Atrial Fibrillation Versus Those With Normal Sinus Rhythm
Kim, H., Kim, Y., Shin, J., et al. (2007) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2007.04.060 · Cited by 15
Could successful cryoballoon ablation of paroxysmal atrial fibrillation prevent progressive left atrial remodeling?
Erdei, T., Dénes, M., Kardos, A., et al. (2012) · Cardiovascular Ultrasound · doi:10.1186/1476-7120-10-11 · Cited by 15
“The relationship between left atrial (LA) dilatation and atrial fibrillation (AF) has been widely accepted for a long time [1].”
Background
Left Atrial Volume as a Predictor of Left Ventricular Functional Recovery in Patients With Dilated Cardiomyopathy and Absence of Delayed Enhancement in Cardiac Magnetic Resonance
Moon, J., Shim, C. Y., Kim, Y. J., et al. (2015) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2015.12.011 · Cited by 15
“Determinants of LA volume are ventricular diastolic function, the severity of MR, the presence of atrial fibrillation and the degree of ventricular remodeling and they are known to be associated with poor prognosis in advanced heart failure[24, 28-31].”
Background
Differential Left Atrial Remodeling in LV Diastolic Dysfunction and Mitral Regurgitation
Maiello, M. R., Sharma, R. K., Ciccone, M. M., Reddy, H. K., & Palmiero, P. (2009) · Echocardiography · doi:10.1111/j.1540-8175.2008.00889.x · Cited by 16
Atrial Remodeling And Atrial Fibrillation: Mechanistic Interactions And Clinical Implications.
Ghamdi, B. A., & Hassan, W. (2009) · Europe PMC (PubMed Central) · doi:10.4022/jafib.125 · Cited by 15
Indications for TEE Before Cardioversion for Atrial Fibrillation: Implications for Appropriateness Criteria
Grewal, G., Klosterman, T. B., Shrestha, K. L., et al. (2012) · JACC. Cardiovascular imaging · doi:10.1016/j.jcmg.2011.12.020 · Cited by 15
“It is known that prolonged AF results in atrial enlargement in humans (11).”
Background
Comparison of Tricuspid Annular Plane Systolic Excursion in Patients With Atrial Fibrillation Versus Sinus Rhythm
Torii, Y., Kusunose, K., Yamada, H., et al. (2015) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2015.10.035 · Cited by 15
The predictive value of plasma brain natriuretic peptide for the recurrence of atrial fibrillation six months after external cardioversion.
Arı, H., Binici, S., Arı, S., Akkaya, M., Koca, V., Bozat, T., & Gürdoğan, M. (2008) · PubMed · Cited by 15
Serum N-Acetylneuraminic Acid Is Associated with Atrial Fibrillation and Left Atrial Enlargement
Hu, W. G., Xie, J., Zhu, T., Meng, G., Wang, M., Zhou, Z., Guo, F., Chen, H., Wang, Z., Wang, S., et al. (2020) · Cardiology Research and Practice · doi:10.1155/2020/1358098 · Cited by 14
“Left atrial enlargement can occur as a consequence of AF [21, 22]; therefore, the increase in the plasma Neu5Ac level may also be a consequence of AF and atrial cardiomyopathy.”
Background
Prevalence of significant tricuspid regurgitation in patients with successful percutaneous mitral valvuloplasty for mitral stenosis: results from 12 years' follow-up of one centre prospective registry
Lee, S.-P., Kim, H., Kim, K., et al. (2012) · Heart · doi:10.1136/heartjnl-2012-302602 · Cited by 14
Right atrium size in the general population
Keller, K., Sinning, C., Schulz, A., et al. (2021) · Scientific Reports · doi:10.1038/s41598-021-01968-y · Cited by 14
Manejo de los pacientes con fibrilación auricular en los servicios de urgencias hospitalarios (actualización 2012)
Martı́n, A., Lozano, I. F., Puig, B. C.-V., Tercedor, L., del Arco, C., Ynsaurriaga, F. A., Méndez, C. S., & Girbau, L. M. (2012) · Emergencias · Cited by 14
Prognostic Implication of the Left Atrial Appendage Mechanical Reserve After Cardioversion of Atrial Fibrillation
Park, M. Y., Shin, S., Oh, W.-J., et al. (2008) · Circulation Journal · doi:10.1253/circj.72.256 · Cited by 14
The Cognitive Impact of Atrial Fibrillation
Gross, A. F., & Stern, T. A. (2013) · The Primary Care Companion For CNS Disorders · doi:10.4088/pcc.12f01471 · Cited by 14
Atrial Remodeling After Mitral Valve Surgery in Patients with Permanent Atrial Fibrillation
Hornero, F., Rodríguez, I., Buendía, J., et al. (2004) · Journal of Cardiac Surgery · doi:10.1111/j.0886-0440.2004.04076.x · Cited by 14
Usefulness of the MrWALLETS Scoring System to Predict First Diagnosed Atrial Fibrillation in Patients With Ischemic Stroke
Muscari, A., Bonfiglioli, A., Faccioli, L., Ghinelli, M., Magalotti, D., Manzetto, F., Pontarin, A., Puddu, G. M., Spinardi, L., Tubertini, E., et al. (2017) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2016.12.009 · Cited by 14
Macro- and micromechanical remodelling in the fish atrium is associated with regulation of collagen 1 alpha 3 chain expression
Keen, A. N., Fenna, A. J., McConnell, J. C., Sherratt, M. J., Gardner, P., & Shiels, H. A. (2018) · Pflügers Archiv - European Journal of Physiology · doi:10.1007/s00424-018-2140-1 · Cited by 14
“Symptoms can be self-perpetuating with atrial fibrillation contributing to atrial dilation and the occurrence and maintenance of fibrosis [67, 72, 41].”
Background
Association of Common Variations on Chromosome 4q25 and Left Atrial Volume in Patients with Atrial Fibrillation
Mints, Y. Y., Yarmohammadi, H., Khurram, I. M., et al. (2015) · Clinical Medicine Insights Cardiology · doi:10.4137/cmc.s21712 · Cited by 14
The role of Arrhythmias in the Progression of Heart Failure
Ferrari, G. M. D., & Tavazzi, L. (1999) · European Journal of Heart Failure · doi:10.1016/s1388-9842(99)00004-5 · Cited by 14
“This includes ultrastructural changes [24], an increase in atrial size [25], and a decrease in atrial contractility [26] that represent the anatomical and mechanical counterparts of the remodelling process, as well as a progressive depletion of atrial natriuretic peptide leading to an 'endocrinological silence' [27] I…”
Background
ELECTROPHYSIOLOGIC ASPECTS OF HUMAN ATRIAL FIBRILLATION
Lindsay, B. D., & Smith, J. M. (1996) · Cardiology Clinics · doi:10.1016/s0733-8651(05)70299-x · Cited by 14
Predictive Value of Inflammatory Scores for Left Atrium Thrombosis in Ischemic Stroke Without Atrial Fibrillation
Çiçek, V., Kılıç, Ş., Doğan, S., et al. (2024) · Medicina · doi:10.3390/medicina60122046 · Cited by 13
“Previous studies have reported that a direct relationship was observed between thrombus occurrence and LA size [50].”
Drugs in phase I and II clinical development for the prevention of stroke in patients with atrial fibrillation
Bentley, R., Hardy, L., Scott, L. J., Sharma, P., Philippou, H., & Lip, G. Y. H. (2021) · Expert Opinion on Investigational Drugs · doi:10.1080/13543784.2021.1897786 · Cited by 13
Epidemiologie des Vorhofflimmerns
Sack, S. (2002) · Herz · doi:10.1007/s00059-002-2395-2 · Cited by 13
Left atrial volume: an old echocardiographic measure with renewed prognostic significance: a study in patients with dilated cardiomyopathy.
Galrinho, A., Branco, L. M., Soares, R. M., et al. (2009) · PubMed · Cited by 13
Spatial relationship between left atrial roof or superior pulmonary veins and bronchi or pulmonary arteries by dual-source computed tomography: implication for preventing injury of bronchi and pulmonary arteries during atrial fibrillation ablation
LI, Y., Yang, M. Z., Li, Y. R., Wang, Q., Yu, L., & Sun, J. (2011) · EP Europace · doi:10.1093/europace/eur034 · Cited by 13
“16,17 The relationship between the left atrium roof and the bronchi or pulmonary arteries Trachea divides into left and right principal bronchi above PAs.”
Background
Acute decompensated heart failure as a reason of premature chemotherapy discontinuation may be independent of a lifetime doxorubicin dose in lymphoma patients with cardiovascular disorders
Szmit, S., Jurczak, W. J., Zaucha, J. M., Długosz‐Danecka, M., Sosnowska‐Pasiarska, B., Chmielowska, E., Joks, M., Drozd-Sokolowska, J. E., Knopińska‐Posłuszny, W., Spychałowicz, W., et al. (2017) · International Journal of Cardiology · doi:10.1016/j.ijcard.2017.02.073 · Cited by 13
Combined Catheter Ablation for Atrial Fibrillation and Watchman® Left Atrial Appendage Occlusion Procedures: A Single Centre Experience.
Walker, D. T., Humphries, J., & Phillips, K. P. (2012) · Europe PMC (PubMed Central) · doi:10.4022/jafib.687 · Cited by 14
Impact of Left Atrial Sphericity Index on the Outcome of Catheter Ablation for Atrial Fibrillation
Shi, J., Xu, S., Chen, L., Wu, B., Yang, K., Chen, S., Zhou, D., Zhang, B., Xuan, T., & Hu, X. (2021) · Journal of Cardiovascular Translational Research · doi:10.1007/s12265-020-10093-6 · Cited by 13
Atrial fibrillation is an independent determinant of increased NT-proBNP levels in outpatients with signs and symptoms of heart failure
Jug, B., Šebeštjen, M., Šabović, M., et al. (2009) · Wiener klinische Wochenschrift · doi:10.1007/s00508-009-1269-5 · Cited by 13
“Moreover, lack of independent association between atrial fibrillation and NT-proBNP levels in previous studies was mainly attributed to confounding factors such as older age and left atrial overload (a consequence of increased left ventricular enddiastolic pressure [14–16], mitral insufficiency [17] and increased hear…”
Background
Mid-regional pro atrial natriuretic peptide allows the accurate identification of patients with atrial fibrillation of short time of onset: A pilot study
Meune, C., Vermillet, A., Wahbi, K., Guerin, S., Aelion, H., Weber, S., & Chenevier‐Gobeaux, C. (2011) · Clinical Biochemistry · doi:10.1016/j.clinbiochem.2011.08.906 · Cited by 13
“This could suggest that atrial stretch and strain increases within the first weeks of AF, and then slightly decreases with the prolongation of AF as a consequence of progressive atrial enlargement [23].”
Background
Effects of Left Atrial Dilatation on the Endocardial Atrial Defibrillation Threshold: A Study in an Ovine Model of Pacing Induced Dilated Cardiomyopathy
POWER, J. M., BEACOM, G. A., Alferness, C. A., et al. (1998) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.1998.tb00248.x · Cited by 13
“Allessie and co-workers^" found that there was a critical numher (4-6) of wavelets necessary for AF to persist.”
Background
Predictors of Atrial Defibrillation Threshold in Internal Cardioversion
Boriani, G., Biffi, M., CAMANINI, C., et al. (2000) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2000.tb07048.x · Cited by 13
“Right atrial volume was then calculated by the ellipsoid formula, assuming equivalent anteroposterior and mediolateral di mensions.(7) All measurements were made in endsystole along the line of maximum separation between the chamber walls with the inner edgeinner edge convention.”
MethodInfluential
Computed tomography measurement for left atrial appendage closure
Asami, M., & the OCEAN-SHD Investigators (2022) · Cardiovascular Intervention and Therapeutics · doi:10.1007/s12928-022-00852-4 · Cited by 12

Authors: Sanfilippo, A. J., Abascal, V. M., Sheehan, M., Oertel, L. B., Harrigan, P., Hughes, R. A., & Weyman, A. E.
Affiliations: Harvard University (US)
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 1990-09
Volume: 82
Issue: 3
Pages: 792-797
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/01.cir.82.3.792
OpenAlex: W2102450596
Cited by: 739
References: 0
Citations by year: 2026: 11 · 2025: 17 · 2024: 28 · 2023: 21 · 2022: 23 · 2021: 16 · 2020: 32 · 2019: 17 · 2018: 21 · 2017: 27 · 2016: 28 · 2015: 22 · 2014: 28 · 2013: 24 · 2012: 30
FWCI: 7.96
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Circulation (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
Keywords: atrial fibrillation, atrial enlargement, left atrial volume, right atrial volume, left atrial diameter, left ventricular dimensions, sinus rhythm maintenance, atrial remodeling
MeSH terms: Aged, Atrial Fibrillation, Echocardiography, Female, Heart Atria, Cardiomegaly, Heart Ventricles, Humans, Male, Middle Aged, Mitral Valve Insufficiency, Myocardium, Prospective Studies, Observer Variation

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Atrial enlargement as a consequence of atrial fibrillation. A prospective echocardiographic study.

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