Are Echocardiographic Parameters Associated with Atrial Fibrillation Recurrence Or Stroke

1290, Either, Cat; 45

ARE ECHOCARDIOGRAPHIC PARAMETERS ASSOCIATED WITH ATRIAL FIBRILLATION RECURRENCE OR STROKE? RESULTS FROM THE AFFIRM STUDY

B Olshansky1 , EN Heller2, LB Mitchell3, W Slater4, M Green5, M Brodsky6,

M Chandler7, P Barrell7, HL Greene7

1University of Iowa, Iowa City, IA, USA, 2Bronx Lebanon Hospital Center, Bronx, NY, USA, 3Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada, 4New York University Medical Center, New York, NY, USA, 5University of Ottawa, Ottawa, Ontario, Canada, 6University of California-Irvine, Irvine, CA, USA, 7Axio Research Corporation, Seattle, WA, USA

Background: The AFFIRM Study, evaluating elderly patients with atrial fibrillation (AF) at risk for stroke, offered the possibility to evaluate the association of echocardiographic left atrial (LA) diameter and recurrent AF. Methods: Patients in the AFFIRM Study rate-control and rhythm-control arms who had sinus rhythm resume and had echocardiographic measures of LA diameter were included. Risk for recurrent AF was evaluated with respect to echocardiographic LA diameter. Results: Of 2474 patients studied, 457 had greater to or equal 2 plus out of 4 plus MR, and 726 had LA diameter more than 4.5 cm. The cumulative probabilities of at least one AF recurrence of stroke were 46 percent of 1 percent after one year and 84 percent of 5 percent by the end of the trial (more than 5 years) respectively. Multivariate analysis revealed that randomization to the rhythm control arm (HR equals 0.64; p less than 0.0001) and a qualifying episode of AF being the first known episode (HR equals 0.70; p less than 0.0001) were associated with decreased risk. LA diameter (p equals 0.008) was associated with increased risk of recurrent AF and the larger the diameter, the greater the risk (HR equals 1.21, 1.16 and 1.32 for mild, moderate, and severe enlargement, respectively). LA diameter was not associated with risk of stroke. Conclusions: In the AFFIRM Study, large transthoracic echocardiographic LA diameters were associated with recurrent AF but not with stroke.