Left atrial volume predicts cardiovascular events in patients originally diagnosed with lone atrial fibrillation: three-decade follow-up

We read with great interest the study of Osranek et al.1 on the left atrial volume as a predictor of cardiovascular events in patients originally diagnosed with lone atrial fibrillation (AF). Patients diagnosed with lone AF and normal left atria volume have a benign clinical course, in contrast to patients with increased left atrial volume who developed adverse events, i.e. death, cerebral infarction, myocardial infarction, and congestive heart failure, during the three-decade follow-up. The authors suggest the use of left atrial volume measurement for risk stratification and monitoring of patients with AF. Unfortunately, in this study, diastolic function, as underlying aetiology of AF, was not measured. Although difficult to measure, diastolic dysfunction is known as risk factor for AF,2 and earlier studies have shown that diastolic dysfunction is present in patients diagnosed with lone AF.3 In this study, it remains uncertain, whether the patients with enlarged left atrial volume, indicating elevated left ventricular filling pressures are correctly diagnosed as lone AF. The notion exists that this might represent patients with underlying diastolic dysfunction, rather than lone AF, with a different clinical course.