Abstract TP231: Echocardiographically Identified Left Atrial Enlargement is Associated With Non-valvular Paroxysmal Atrial Fibrillation (PAF) and is a Surrogate for PAF Associated Risk for Embolic Stroke

Abstract

Introduction: Paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation are risk factors for systemic embolism including stroke. Both are indication for anticoagulation. Many patients with stroke in sinus rhythm are shown on ambulatory ECG monitoring to have PAF. PAF is difficult to diagnose on ambulatory ECG monitoring. A persistent marker for PAF will be useful to identify need for anticoagulant to reduce stroke risk due to PAF. Echocardiographic variable with a high predictive value for PAF is desirable. Objective: The purpose of the study was to investigate the relationship between left atrial (LA) size and proneness to paroxysmal atrial fibrillation and assess its reliability as a surrogate for diagnosing non valvular PAF. Method: Echo Database for patients with measured LA volume index, in sinus rhythm without history of intervention for atrial fibrillation, pharmacological therapy, and cardioversion or ablation therapy over a seven year period was reviewed. Patients with enlarged LA Volume index (>28ml/M 2 ) were selected. Seven Day ambulatory ECG monitoring was performed in these patients, ResultEchocardiogram data of 245 patients were available for analysis. 41 had greater than mild mitral valve regurgitation and were excluded from further analysis. Age range was 37-93. 99 were male. 211 patients had LA volume index data available. In 8 patients in sinus rhythm on ambulatory ECG, LA volume index was mildly increased (28-34 ml/M 2) In 16 patients with PAF on ambulatory ECG, LA volume index was mildly increased (28-34 ml/M 2 ) In 100 patients with PAF on ambulatory ECG, LA volume index was moderately increased (35-40 ml/M 2 ) In 88 patients with PAF on ambulatory ECG, LA volume index was severely increased (>40 ml/M 2 ) Conclusion: In patients with moderately and severely enlarged LA volume index, there was a high prevalence of paroxysmal atrial fibrillation on ambulatory ECG monitoring. Left Atrial volume index could serve as an echocardiographic surrogate for PAF and identify indication for anticoagulation to reduce stroke risk. It Is More Easily Identifiable Surrogate For PAF Than Ambulatory ECG Monitoring In Stroke Risk Assessment.