The discriminative ability of the widely used CHADS2 and CHA2DS2-VASc scores for risk stratification of thromboembolism in atrial fibrillation (AF) is known as modest. Some echocardiographic parameters are known risk factors for thromboembolism. This study aimed to evaluate whether combining echocardiographic parameters with CHADS2 and CHA2DS2-VASc scores can improve the predictive power for embolic risk in AF.A total of 526 (F/M = 83/433, mean age = 57.6 ± 10.7 years) patients with non-valvular AF were enrolled. The predictability for left atrial (LA) thrombus or dense spontaneous echo contrast (SEC) using clinical scores or echocardiographic parameters or combining clinical scores and echocardiographic parameters was calculated and compared.Dense SEC or thrombus was present in 51 patients. The predicting powers of the CHADS2 and CHADS2-VASc scores for the presence of dense SEC or thrombus were modest (c-statistics 0.65 and 0.68, respectively, 95% confidence interval [CI] 0.61-0.69 and 0.64-0.74, respectively, both P < 0.001). Impaired LA function was the most descriptive predictor for the presence of thrombus or dense SEC among echocardiographic parameters. Combining impaired LA function (LA emptying fraction < 30%) with the CHADS2 and CHA2DS2-VASc scores showed the improvement of predictive power in detecting dense SEC or thrombus (c-statistics 0.78 and 95% CI 0.74-0.81 and c-statistics 0.77 and 95% CI 0.73-0.81, respectively, both P < 0.001).Adding LA functional markers to the CHADS2 or CHA2DS2-VASc score improved the predictive value of the presence of thrombus or dense SEC. In clinical situations, anticoagulation should be considered to prevent embolism in patients with low-risk scores when they have LA dysfunction.

SummaryThe aim of this study was to assess the clinical and echocardiographic predictors for the recurrence of persistent atrial fibrillation (AF) after ablation during a long-term period.A total of 130 patients with persistent AF who had undergone radiofrequency catheter ablation (RFCA) were enrolled. We analyzed the relation between clinical parameters, echocardiographic parameters, and AF recurrences at 6 months, 1 year, and 2 years after ablation.During the 2-year follow-up, AF recurred in 61 patients (46.6%). In the 6 month follow-up, AF recurrence was associated only with total ablation time only. However, during the 1-year and 2-year follow-up periods, the presence of hypertension, impaired left atrial (LA) emptying fraction (eF) (≤ 20%), decreased LA appendage (LAA) emptying velocity (≤ 20 cm/sec), and LAAeF (≤ 20%) were correlated with AF recurrence (odds ratio [OR] = 1.87, 2.45, 1.93, and 2.15 respectively, P = 0.016, 0.004, 0.029, and 0.004 respectively). Among these factors, impaired LAeF was the only independent predictor of AF recurrence in multivariate analysis (OR = 2.81, P = 0.012).In patients with persistent AF who had undergone RFCA, the best predictor of AF recurrence after ablation varied according to the follow-up period. Diminished LA function was the only predictor of recurrence in the 2-year follow-up. Pre-procedural assessment of LA function might be helpful in selecting those patients who would benefit from RFCA. (Int Heart J 2014; 55: 312-318) Key words: Atrial fibrillation recurrence, Left atrial function, Radiofrequency catheter ablation, Echocardiographic predictors R adiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) has evolved as an effective therapeutic option in the last decade. RFCA is considered to be a potentially curative treatment to restore sinus rhythm (SR) by eliminating the focus of arrhythmia and modifying the left atrial (LA) structural substrate of AF. However, the recurrence rate after RFCA remains unsatisfactory (15% to ≥ 50%) depending on the ablation strategy and the type of AF.1,2) RFCA is an expensive procedure with potentially critical complications. 3)Thus, it is crucial to identify those patients who are most likely to benefit from AF ablation with respect to restoration of the SR. Several clinical parameters, biomarkers, and imaging parameters have been reported to predict AF recurrence after RFCA. The reported predictors of recurrence after ablation are the presence of hypertension, long duration of AF, prolonged procedural time, enlarged LA diameter (LAD), or increased LA volume (LAV) and decreased LA function. [4][5][6][7][8][9] However, there is no consensus regarding the risk factors for recurrence because of heterogeneities in the study population, differences in the follow-up period, and differences in the type of AF.Echocardiography has a well-recognized and essential role in the current guidelines for the assessment of cardiac structure and function in patients with AF.10) Several echocardiographic parameters for predicting th...

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