Left atrial remodeling in patients with atrial septal defects

BACKGROUND Information regarding Left atrial (LA) substrate in conditions predisposing to atrial fibrillation (AF) is limited. OBJECTIVE This study sought to characterize the Left atrial remodeling that results from chronic atrial stretch caused by atrial septal defect (ASD). METHODS Eleven patients with hemodynamically significant ASDs and 12 control subjects were studied. The following were evaluated using multipolar catheters: effective refractory period (ERP) at 7 sites, P-wave duration (PWD), conduction time, and inducibility of AF. LA electroanatomic maps were created to determine atrial activation, and regional conduction and voltage abnormalities. RESULTS Patients with ASDs showed significant LA enlargement (P <0.001), unchanged or prolonged atrial ERPs, increase in LA conduction times (P = 0.03), prolonged PWD (P <0.001), regional conduction stowing (P <0.001), greater number of double potentials or fractionated etectrograms (P <0.0001), reduced atrial voltage (P <0.001), and more frequent electrical scar (P = 0.005) compared with control subjects. In addition, patients with ASDs showed a greater propensity for sustained AF with single extra-stimuli (4 of 11 vs. 0 of 12, P = 0.04). CONCLUSION ASDs are associated with chronic Left atrial stretch, which results in remodeling characterized by LA enlargement, toss of myocardium, and electrical scar that results in widespread conduction abnormalities but with no change or an increase in ERP. These abnormalities were associated with a greater propensity for sustained AF.