Left atrial appendage flow velocity predicts recurrence of atrial fibrillation after catheter ablation: A systematic review and meta-analysis

Abstract

PurposeThere is increasing evidence that left atrial appendage flow velocity (LAAFV) is linked to the recurrence of atrial fibrillation (AF) after catheter ablation (CA), suggesting the potential predictable significance of LAAFV in this setting. We performed a systematic review and meta-analysis to assess whether LAAFV is association with AF recurrence after CA.MethodsUp to May 1, 2022, six databases (PubMed, EMBASE, Web of Science, Cochrane Library, Scopus, and CINAHL) were searched for literature reporting the association between LAAFV and AF recurrence after CA. All statistical analyses were carried out using STATA version 16 software. Heterogeneity was determined by the Cochrane’s Q test and I2 statistics. The Newcastle-Ottawa Scale (NOS) was used to assess the methodological quality of each included study, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was adopted to evaluate the quality of evidence.ResultSixteen studies with 5,006 AF patients after CA (1,479 patients with AF recurrence, 3,527 without AF recurrence) were included in the meta-analysis. The meta-analysis of 15 studies (16 data sets) showed that patients with recurrence exhibited lower LAAFV values than those without recurrence [standardized mean difference (SMD): −0.65, 95% CI: −0.88 to −0.42, P < 0.01]. Moreover, we evaluated the association of LAAFV and the risk of AF recurrence after CA. Nine studies (11 data sets) defined LAAFV as continuous variables, and the pooled analysis suggested that for every 1 cm/s rise in LAAFV values, the risk of AF recurrence after CA decreased by 3% [Odds Ratio (OR): 0.97, 95% CI: 0.95 to 0.99, P < 0.01]. Seven studies defined LAAFV as categorical variables, and the pooled analysis showed that lower LAAFV were associated with an increased risk of AF recurrence after CA [OR: 2.28, 95% CI: 1.46 to 3.57, P < 0.01]. The subgroup analyses showed that the association between LAAFV and AF recurrence after CA was not significantly affected by the AF type and ablation procedure. The NOS indicated that included studies were moderate to high quality, while the GRADE assessment suggested a low certainty of the evidence.ConclusionLower LAAFV may be associated with an increased risk of AF recurrence after CA. Further studies with well designed and randomized studies for LAAFV should be conducted.Systematic review registration[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42022333627].

Left atrial appendage doppler velocity as a predictor of recurrence of atrial fibrillation after transesophageal echocardiogram guided electrical cardioversion

“… [13] As impaired LA function can precede LA expansion, particularly in patients with paroxysmal AF, LAAV is a more sensitive predictor for sinus rhythm maintenance and AF recurrence than LA size. [8] .…”

“… [6] , [7] The average left atrial appendage emptying velocity (LAAV) is a recognized marker of LAA function considering contractility, stunning, and fibrosis. [8] Despite LAAV serving as a marker of LAA function and being able to be easily calculated by Doppler during pre-ECV transesophageal echocardiogram (TEE), there is a paucity of data on the role of LAAV in predicting the risk of AF recurrence after ECV. Thus, we performed this study to evaluate whether LAAV is associated with an increased risk of AF recurrence after ECV.…”

Predicting reduced left atrial appendage velocity from echocardiographic left atrial function parameters in patients with atrial fibrillation undergoing catheter ablation

“…Ueno et al 7 revealed that LAAV < 37.5 cm/s could predict AF detected with an insertable cardiac monitor in patients with cryptogenic stroke. Two large meta-analyses have also shown that LAAV is one of the factors that increases the likelihood of AF recurrence after catheter ablation 8 , 9 . Raval et al 10 reported that LAAV ≤ 30 cm/s was independently associated with an increased risk of AF recurrence after TEE-guided electrical cardioversion.…”

Relationship between left atrial appendage peak flow velocity and nonvalvular atrial fibrillation recurrence after cryoablation

“…So far, only a few studies have mentioned the relationship between left atrial appendage peak flow velocity (LAA-PEV) and persistent AF recurrence (8). However, these studies focused on the link between LAA-PEV and persistent AF recurrence after initial radiofrequency ablation (9), otherwise the correlation between LAA-PEV and paroxysmal AF recurrence after cryoballoon ablation is not established. The STOP Persistent AF Trial demonstrated cryoballoon ablation is safe and effective in treating patients with persistent AF.…”