Atrial mechanical remodeling and new onset atrial fibrillation in chronic Chagas' heart disease

Abstract

Atrial fibrillation (AF) is a common arrhythmia, mechanistically linked to underlying heart disease. AF affects about one fifth of subjects with Chagas' heart disease and is a harbinger of poor prognosis. In a retrospective longitudinal analysis, 50 subjects were investigated in long-term follow-up for the first documented atrial fibrillation (AF) episode. During a follow-up of (mean+/-SD) 84.2+/-39.0 months, nine subjects developed AF (incidence: 3.3+/-1.0%/year). Five subjects had nonfatal embolic stroke and nine died due to cardiac causes. The relative risk of AF for stroke was 3.0 (p=0.22) and for cardiac death was 3.6 (p=0.04). A faster left atrial diameter (LAD) enlargement during follow-up was tracked in subjects with more severe cardiac damage at presentation, and large LAD was detected at both presentation (p=0.02) and end of follow-up (p=0.002) in subjects who experienced AF. Atrial remodeling in chronic Chagas' disease is associated with severity of underlying heart disease at presentation and impacts AF incidence in this population.