Clinical value of left atrial appendage flow velocity for predicting of cardioversion success in patients with non-valvular atrial fibrillation*1

Pálinkás, Attila; Antonielli, E; Picaño, Eugenio; Pizzuti, A; Varga, Albert; Nyúzó, Bálint; Alegret, Josep M.; Bonzano, Alessandro; Tanga, M; Coppolino, A; Forster, Tamás; Baralis, Giorgio; Delnevo, Fabrizio; Csanády, Miklós

doi:10.1053/euhj.2001.2891

Cited by 46 publications

(32 citation statements)

References 24 publications

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“…Although there is increasing evidence of the LAA importance as a trigger for atrial arrhythmias, the literature is scarce on the mechanisms and factors that may contribute to it. Previous studies have demonstrated the value of LAA flow velocity in the prediction of sinus rhythm maintenance after electrical cardioversion and, recently, Kanda et al described an association between low LAA flow velocity and AF recurrence after catheter ablation in patients with persistent AF [28][29][30]. The current research suggests that LAA volume may be a surrogate of increased LAA arrhythmogenicity, similar to what happens with the LA volume: an enlarged LA is associated with electrical remodelling, which provides an arrhythmogenic substrate for AF triggers [31].…”

Section: Discussionmentioning

confidence: 99%

Left atrial appendage volume as a new predictor of atrial fibrillation recurrence after catheter ablation

Teixeira

Oliveira

Ramos

et al. 2017

J Interv Card Electrophysiol

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Purpose Recurrence of atrial fibrillation (AF) after catheter ablation is common, being clinically relevant to identify predictors of recurrence. The left atrial appendage (LAA) role as an AF trigger is scarcely explored. Our aim was to identify if LAA volume is an independent predictor of AF recurrence after catheter ablation. Methods We analysed 52 patients (aged 54 ± 10 years, 58% male) with paroxysmal and persistent AF who underwent a first AF catheter ablation and had performed contrast-enhanced cardiac computed tomography (CT) prior to the procedure. Results The mean left atrial and LAA volumes measured by cardiac CT were 98.9 ± 31.8 and 9.3 ± 3.5 mL, respectively. All patients received successful pulmonary vein isolation and were followed up for 24 months. AF recurrence occurred in 17 patients (33%). LAA volume was significantly greater in patients with AF recurrence than in those without recurrence (11.3 ± 2.9 vs. 8.2 ± 3.4 mL; p = 0.002). Multivariable analysis using Cox regression revealed that LAA volume (hazard ratio 1.32; 95% confidence interval 1.12-1.55; p = 0.001) and persistent AF (hazard ratio 4.22; 95% confidence interval 1.48-12.07; p = 0.007) were independent predictors for AF recurrence. An LAA volume greater than 8.825 mL predicted AF recurrence with 94% sensitivity and 66% specificity. The Kaplan-Meier analysis showed a lower rate free from AF recurrence in the group with an LAA volume >8.825 mL (p < 0.001).Conclusions Larger LAA volume was associated with AF recurrence after catheter ablation in patients with paroxysmal and persistent AF.

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Section: Discussionmentioning

confidence: 99%

Left atrial appendage volume as a new predictor of atrial fibrillation recurrence after catheter ablation

Teixeira

Oliveira

Ramos

et al. 2017

J Interv Card Electrophysiol

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“…Recent reports have suggested that cardioversion success of atrial fibrillation may be predicted by the assessment of LAA flow velocity before cardioversion, but some methodological problems have weaken the outcomes of these studies, and moreover, some other studies have not confirmed their findings (Mitusch et al 1995;Verhost et al 1997). Palinkas et al (2001) studied the role of LAA flow velocity by TEE for prediction of cardioversion outcome before cardioversion in patients with nonvalvular atrial fibrillation. Their prospective multicenter study consisted of larger sample size and strict selection criteria (duration of atrial fibrillation was less than 1 year).…”

Section: Discussionmentioning

confidence: 99%

“…LAA flow velocity may also represent LAA contractile function. Recent studies have suggested that the conversion from atrial fibrillation to sinus rhythm may be predicted by evaluating LAA velocities before cardioversion (Mitusch et al 1995;Tabata et al 1997;Palinkas et al 2001). However, there have been conflicting data in the literature (Perez et al 1997;Verhost et al 1997).…”

confidence: 99%

Left Atrial Appendage-Flow Velocity Predicts Cardioversion Success in Atrial Fibrillation

Akdeniz

Badak

Barış

et al. 2006

Tohoku J. Exp. Med.

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Restoration of sinus rhythm by electrical cardioversion is a therapeutic option in appropriately selected patients with atrial fibrillation. It is important to determine predictors of electrical cardioversion outcome in patients with atrial fibrillation. Predictive value of clinical and conventional echocardiographic parameters for predicting cardioversion outcome is limited. The role of left atrial appendage (LAA) function, which may reflect left atrial contractile function, for prediction of cardioversion outcome remains unclear. We conducted a single center prospective study to evaluate the role of LAA function for prediction of cardioversion success in patients with atrial fibrillation. One hundred sixty three patients with atrial fibrillation underwent transthoracic and transesophageal echocardiography (TEE) before electrical cardioversion. LAA functions, including LAA peak flow velocity, LAA area and LAA ejection fraction, were examined. Cardioversion was successful in 133 patients and unsuccessful in 30 patients. Mean LAA peak emptying flow velocity was significantly higher in the patients with successful cardioversion than in those with unsuccessful cardioversion (0.34 ± 0.14 vs 0.27 ± 0.1 m/sec; p = 0.013). At multivariate logistic regression analysis, only LAA flow velocity (> 0.28 m/sec, odds ratio = 2.8 ; p = 0.03) proved to be an independent predictor of cardioversion success. LAA area ( p = 0.18) and LAA ejection fraction ( p = 0.52) were not different between successful and unsuccessful cardioversion groups. Therefore, measurement of LAA flow velocity provides valuable information for prediction of cardioversion outcome in patients with atrial fibrillation before TEE guided cardioversion.cardioversion; left atrial appendage (LAA) function; atrial fibrillation

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“…[8][9][10][11][12] The relationship between the LAA-V and cardiac rhythm has been described in patients who underwent cardioversion of persistent AF. [16][17][18][19][20] If LA function was maintained at a certain level, patients were more easily kept in SR after PV-cryo. However, we sometimes encountered patients with AF in which an LA contraction could hardly be recognized.…”

Section: Relation Between the Laa-v And Long-term Resultsmentioning

confidence: 99%

“…However, our subjects included some with a long AF-D (>10 years; n=18, 18% of all patients), large LAD (=60 mm; n=28, 28% of all patients), or low LAA-V (=20 cm/s; n=38, 38% of all patients). Long-standing AF, 14,15 a large left atrium, 14,15 and low LAA-V [16][17][18][19][20] all are considered negative predictive factors for both recovery and maintenance of SR.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

Left Atrial Appendage Outflow Velocity is Superior to Conventional Criteria for Predicting of Maintenance of Sinus Rhythm After Simple Cryoablation of Pulmonary Vein Orifices

Isobe

Taniguchi

Kono

et al. 2005

Circ J

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ince Haissaguerre et al reported that most atrial premature beats that initiate atrial fibrillation (AF) originate in the pulmonary veins (PV), various surgical techniques have been devised to isolated PV by incision and/or cryoablation. [1][2][3][4][5] In this context, we have used simple surgical cryoablation confined to the 4 PV orifices (PV-cryo) to eliminate chronic AF in appropriate patients undergoing cardiac surgery since 1999. We previously reported initial results in which 70% of patients showed sinus rhythm (SR) at discharge from the hospital. 6 Furthermore, we found that the duration of AF (AF-D), left atrial dimension (LAD), and the mean of peak left atrial appendage outflow velocities (LAA-V) before operation were important factors in assessing the likelihood of successful conversion from AF to SR. 6 In this study, the patients were followed up for a relatively long period of time to determine whether maintenance of SR was related to these variables as well as which of the variables was the best long-term predictor of SR. Methods PatientsWe carried out PV-cryo as part of a cardiac operation at our hospital in 101 patients with a history of chronic AF.

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Clinical value of left atrial appendage flow velocity for predicting of cardioversion success in patients with non-valvular atrial fibrillation*1

Abstract: In patients with non-valvular atrial fibrillation, measurement of the left atrial appendage flow velocity profile by transoesophageal echocardiography before cardioversion provides valuable information for prediction of cardioversion outcome.

Cited by 46 publications

References 24 publications

Left atrial appendage volume as a new predictor of atrial fibrillation recurrence after catheter ablation

Left atrial appendage volume as a new predictor of atrial fibrillation recurrence after catheter ablation

Left Atrial Appendage-Flow Velocity Predicts Cardioversion Success in Atrial Fibrillation

Left Atrial Appendage Outflow Velocity is Superior to Conventional Criteria for Predicting of Maintenance of Sinus Rhythm After Simple Cryoablation of Pulmonary Vein Orifices

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