Atrial dilatation in Atrial fibrillation : A question with a number of twists!

(That is presupposed to be a ballot. Sorry, readers, you possibly can’t choose the reply. WordPress is just not form sufficient and immediately made the ballot service payable additional. I’m already paying practically a $100 price to take care of this website. I can’t afford any extra.)

We now have been taught Bi-Atrial enlargement is the rule in AF .It’s nonetheless true in most conditions. However, we hardly ever dispute it , & ask which atrium dilates extra in AF ?

Allow us to see few elements.

• Each atria develop from a mix of the primitive atrium, sinus venous, and pulmonary veins.It’s logical to presume there should be a hidden morpho-electrical continuity.
• The baseline RA dimension is a number of mm greater than LA. Additional, it’s thin-walled, extra compliant and can distend relying on volemic standing.
• When atrial fibrillation (AF) begins, it might begin with a single focus, degenerating to a number of wavelets, and it spreads all through all the floor space of each atria. A fibrillatory wave that happens at a charge of greater than 600 beats per minute could cause fatigue in the long term, resulting in atrial dilation.
• Most likely, this dilation is a type of atrial tachycardia and atrial cardiomyopathy. Nevertheless, underlying lesions akin to hypertension, mitral valve illness, COPD, ASD, and TR enormously affect the diploma of atrial enlargement.

Spatial relationship of websites for atrial fibrillation drivers and atrial tachycardia in sufferers with each arrhythmias July 2017 Worldwide Journal of Cardiology 248(3)

• AF begets AF. That is much like MR begets MR. Atrial useful MR happens when the decrease a part of the atria stretches the mitral annulus. You will need to recall {that a} small space of the posterior side of the LA is part of the mitral valve equipment. Due to this fact, AF begetting MR and MR begetting AF shouldn’t be thought-about a humorous rhyme, however somewhat a sensible chance.
• Histopathological specimens of atrial tissue in power AF can current with stunning outcomes. The atrial muscle will be completely regular, or the interstitium will be infiltrated with lipids, fibroblasts, amyloid, and so forth.
• Concerning the difficulty at hand, it’s extensively identified that in instances of mitral stenosis with AF, the left atrium (LA) is bigger than the precise atrium (RA) because of the apparent purpose that the baseline LA was bigger on the onset of AF. Nevertheless, in instances of lone AF, AF in hypertension, or power AF, each atria are likely to dilate equally..

Implications for electrophysiologists.

In distinction to different tachycardias, with atrial fibrillation (AF), the main focus is commonly speculative, and ablation makes an attempt are made accordingly. Pulmonary veins have been the first goal for ablation for a few years, but the success charges stay inconsistent. To find out if the AF focus is non-pulmonary venous, akin to proper atrial, septal, or involving the inferior vena cava (IVC) or superior vena cava (SVC), a number of strategies are employed to impress and localize these non-pulmonary vein triggers

Localized atrial fibrosis and interatrial blocks may end up in differential fibrillatory counts throughout the atria. (RA fib-rate will be greater than LA, and vice versa.) Is there proof for this, or simply a tutorial gossip? We all know atrial flutters will be confined to at least one atrium. (Pierre Jaïs Circulation 2000) When such flutters rework into fibrillation, how does the spillover of alerts happen to the contralateral atrium? On a private be aware, we now have recorded good E & A Doppler alerts throughout the tricuspid valve, in RHD mitral stenosis, and AF. No revealed proof as such. I strongly suspect the precise atrium can resist the tsunami of approaching fibrillatory waves from engulfing its chamber in no less than some sufferers. An enchantment to the brand new era EPs who’ve particular aptitude in AF ought to look into this and both show or disprove it.

Remaining message

My reply to the query is both D or E. Atrial dimension in AF is not a trivial factor to disregard. This query pushes a easy concept. In main or lone AF, simply by taking a look on the RA to LA dimension ratio, one may get an inexpensive guess,concerning the Preliminary focus, set off & pathology of the AF.

A request to all of the excessive profile stake holders concerned within the science of PV ablation (both with Ice or hearth). Take into consideration all of the doable right-sided or septal focuses, earlier than going overzealously for the jugulars of Pulmonary veins, particularly if the RA considerably bigger than LA . This may save time, effort & after all our repute.

References

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