Arterial Loading and the Prevention of Atrial Dysfunction.

The presence of left atrial (LA) dysfunction is linked to the development of both heart failure and atrial fibrillation (AF). Hypertensive heart disease is an important contributor to both LA dysfunction and AF, and hypertension is present in between 50% and 90% of patients in AF trials. In the early phases of hypertension, LA conduit function is impaired, and there is compensation by increased booster function. Although the association of LA dysfunction with heart failure may be mediated through left ventricular (LV) systolic and diastolic dysfunction, the eventual loss of booster function because of AF is an important precipitant of heart failure. Consequently, it seems logical that controlling hypertension and its LV consequences may be a factor in the prevention of AF. Specifically, because LA dysfunction, wall stretch, and enlargement are a consequence of disturbances of LV hemodynamics, a better understanding of the LV systolic–diastolic coupling may have an important role in protecting the LA.