Abstract

Background: Atrial Fibrillation is the most common sustained cardiac arrhythmia and Left Atrial size is an important factor in the development of Atrial Fibrillation. In the presence of Atrial Fibrillation an increase in Left Atrial size is associated with increased risk of stroke as well as increased morbidity and mortality. In this context, this study entitled “Relation between Left Atrial size and Atrial Fibrillation in Rheumatic Heart disease” was undertaken to study the Left Atrial size in Rheumatic Heart disease causing Atrial Fibrillation.

Methods: A one year Cross sectional study was undertaken from March 2014 to February 2015in a Tertiary Cardiac Care Hospital in South Karnataka. 50 cases of Atrial Fibrillation were studied in the present study.

Results: In the present study, age of the patients ranged from 15 years to 70 years with a mean age of 48.12 with standard deviation of 14.354 years. There were 20 males and 30 females with a male-female ration being 1:1.3. 34(68%) patients were > 40 years and 16 (32%) patients were <40 years age group. In this study most common valvular lesions was mitral stenosis, 24 patients with 20 (83.33%) having enlarged and 4 (16.66%) having normal LA with mean LA size of 50.37 mm. 4 patients had isolated MR with all 4(100%) having enlarged LA with mean LA size of 62.75mm. 11 patients had both MS and MR, all had enlarged LA with mean LA size of 56.72 mm. 11 patients had multivalvuar involvement, of them 10 (90.90%) had enlarged LA and 1 (9.09%) had nomal LA with a mean LA size of 51.94 mm. In this study 5 patients (10%) had normal LA size and 45 patients (90%) had enlarged LA. In this study LA size varied from 30 mm to 76 mm with a mean LA size of 52.9 mm. In this study of 50 patients PAH was seen in 48 patients, among them 43 (89.21%) patients had enlarged LA and 5(10.41%) patients had normal LA. In this study congestive cardiac failure was seen in 38 patients among them 33(94.28%) had enlarged LA and 2(5.71%) had normal LA size. In this study of 50 patients, 8 patients had neurological deficits. All of them 8(100%) had enlarged LA. In this study of 50 patients, 4 patients died during the hospital course, All of them 4(100%) had enlarged LA.

Conclusions: Atrial Fibrillation was common in >40 years age group and associated Left Atrial dilatation is also more common in >40 years age group. Left Atrial enlargement in patients with AF is found to be associated with worsening of Functional status, pulmonary arterial hypertension and Congestive cardiac failure. Embolic complications like stroke was more in patients with Atrial Fibrillation and Left Atrial dilatation. This has got some therapeutic implications like prophylactic anticoagulation to prevent embolic complications in patients with Atrial Fibrillation

Keywords: Left Atrial size, Atrial Fibrillation, Rheumatic Heart Disease, LA (Left Atrium).