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

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. (C) 2007 Elsevier Ireland Ltd. All rights reserved.