January 13, 2024Scientific ReportsOpen Access

The relationship of atrial fibrillation with left atrial size in patients with essential hypertension

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Why the study?

Hypertension is a major risk factor for AF, but the prevalence, independent risk factors, and relationship between AF and left atrial size in hypertensive patients required evaluation.

Does increased left atrial size predict the occurrence of atrial fibrillation in patients with essential hypertension?

Structured PICO

Does increased left atrial size predict the occurrence of atrial fibrillation in patients with essential hypertension?

Population

958 patients admitted to the cardiology department (CCU and IMCU) at King Abdullah University Hospital in Irbid, Jordan, with a diagnosis of hypertension. Mean age 61.4 years, 65.4% male.

Comparator

Hypertensive patients without atrial fibrillation (n=814)

Outcome

Prevalence of atrial fibrillation and its independent risk factors, specifically left atrial size

In patients with essential hypertension, increased left atrial size and advancing age are significant independent predictors of atrial fibrillation.

Limitations

Retrospective study design could not identify paroxysmal AF from chronic permanent AF
Unable to include left ventricular mass index because diastolic posterior wall thickness was not measured in the majority of patients

Implication

LA enlargement may flag higher AF risk in hypertension; hypothesis-generating for prospective validation.

Abstract

Atrial fibrillation (AF) is the most common sustained arrhythmia and it is a major public health problem worldwide. Hypertension is one of the major risk factors for the development of AF. This study is carried out to determine the prevalence and independent risk factors for atrial fibrillation (AF) in hypertensive patients and to evaluate the relationship of AF with left atrial size. This is a retrospective observational cross - sectional study that used a retrospective electronic chart review of all admitted patients to cardiology department at King Abdullah university hospital (KAUH) in Irbid, Jordan, with a diagnosis of hypertension along with various acute cardiac admissions, including AF during 1-year period (January 1st to December 31 of 2021). Risk factors for AF (age, sex, DM, coronary artery disease, valvular heart disease, Cor-pulmonale, obstructive sleep apnea, and congestive cardiac failure) were retrieved from electronic charts of the patients. A total of 958 patients were admitted to the coronary care unit (CCU) and intermediate care unit (IMCU) during a 1-year period. Among them, 276 had 2 or 3 admissions. The main reason of admission was acute coronary syndrome (n = 491), heart failure (n = 180), and AF (n = 144), indicating AF prevalence of 15%. However, there were 40 patients with combined causes. All patients in the study (n = 958) were diagnosed with hypertension, including patients with atrial fibrillation (n = 144). The mean age of patients was 61.4 (± 11.46) years, and approximately two thirds of them were males (65.4%). The binary logistic regression model demonstrated a significant statistical relationship of age, left atrial size, coronary artery disease, left ventricular ejection fraction, left ventricular dimensions in systole and diastole, and heart failure with the occurrence of AF after controlling for gender, smoking, and diabetes. Findings indicate that left atrial size plays a significant role in the development of AF in patients with hypertension. However, the prevalence of AF significantly increased with advancing age in both sexes because of increased left ventricular hypertrophy, which leads to increased left atrial size.