Atrial fibrillation (AF) can occur in the presence of left ventricular hypertrophy (LVH).
Pathophysiological link
- Atrial remodeling: The pathophysiological mechanisms underlying AF involve atrial remodeling, which includes changes in electrical, contractile, and structural properties of the atria. These changes can be triggered by chronic atrial stretch due to structural heart disease, such as LVH
- Left atrial volume: Increased left atrial volume, a marker of chronically elevated left ventricular filling pressure, is a predictor of AF
Clinical evidence
- Hypertrophic cardiomyopathy: AF is the most common sustained arrhythmia in hypertrophic cardiomyopathy, a condition characterized by LVH, with clinical and subclinical episodes occurring in nearly one-half of patients
- Heart failure with LV systolic dysfunction: AF is common in patients with heart failure due to left ventricular systolic dysfunction, a condition often associated with LVH
- MESA study: The Multi-Ethnic Study of Atherosclerosis (MESA) found that both cardiac magnetic resonance (CMR) and electrocardiography (ECG)-derived LVH were associated with incident AF in a multiethnic cohort of participants without clinically detected cardiovascular disease
Guidelines
- Hypertension evaluation: The ESH 2023 guidelines recommend obtaining evaluation for hypertension in patients at risk for AF, such as those with high-normal blood pressure, LVH, and left atrial dilatation
In summary, LVH is associated with an increased risk of developing AF due to structural and electrical remodeling of the atria. Clinical evidence supports this association across various conditions characterized by LVH, such as hypertrophic cardiomyopathy and heart failure with systolic dysfunction. Recognizing the link between LVH and AF is important for risk assessment and management in patients with cardiovascular disease.