title: Left atrial volume predicts cardiovascular events in patients originally diagnosed with lone atrial fibrillation: three-decade follow-up.
abstract: OBJECTIVE
  The objectives of this study were to determine the long-term outcome and the predictors of adverse events in patients originally diagnosed with lone atrial fibrillation (AF).
  
  
  RESULTS
  This population-based historical cohort study comprised 46 residents of Olmsted County, MN, USA, with well-documented, clinically defined lone AF and a complete two-dimensional echocardiographic examination. The original echocardiographic videotape recordings were analysed in a blinded fashion for left atrial volume (LAV) and left ventricular ejection fraction. With 1296 person-years of follow-up, the median duration of AF was 27 (first quartile=24, third quartile=33) years. Twenty-three (50%) patients developed events. Cerebral infarction occurred in seven patients, myocardial infarction in 11, and congestive heart failure in 16. In a multivariable analysis, patients with indexed LAV >or=32 mL/m(2) had a significantly worse event-free survival (adjusted HR, 4.46; 95% CI, 1.56-12.74; P=0.005). All cerebral infarctions occurred in patients with an indexed LAV >32 mL/m(2).
  
  
  CONCLUSIONS
  Patients originally diagnosed with benign lone AF follow divergent courses based on LAV. Those originally diagnosed with lone AF and normal sized atria had a benign clinical course throughout the long-term follow-up. Patients with increased LAV at diagnosis or later during the follow-up experienced adverse events.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Osranek
authors.forename: Francesca
authors.initials: F
authors.lastname: Bursi
authors.forename: Kent R
authors.initials: KR
authors.lastname: Bailey
authors.forename: Brandon R
authors.initials: BR
authors.lastname: Grossardt
authors.forename: Robert D
authors.initials: RD
authors.lastname: Brown
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Kopecky
authors.forename: Teresa S
authors.initials: TS
authors.lastname: Tsang
authors.forename: James B
authors.initials: JB
authors.lastname: Seward
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D002306:Cardiac Volume; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D004812:Epidemiologic Methods; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D020521:Stroke / Q000401:mortality; D014463:Ultrasonography