Low left atrial appendage emptying velocity is a predictor of atrial fibrillation recurrence after catheter ablation

Abstract

Background Recurrence of atrial fibrillation (AF) after catheter ablation (CA) remains common and studies have shown about 5%–9% annual recurrence rate after CA. We sought to assess the echocardiogram derived left atrial appendage (LAA) emptying velocity as a predictor of AF recurrence after CA. Objective To determine if LAA emptying is a marker of recurrence of AF post‐CA Methods A total of 303 consecutive patients who underwent CA for AF between 2014 and 2020 were included. Baseline clinical characteristics and echocardiographic data of the patients were obtained by chart review. LAA emptying velocities were obtained from transesophageal echocardiogram (TEE). LA voltage was obtained during the mapping for CA. Chi‐square test and nominal logistic regression were used for statistical analysis. An receiver operator characteristic curve was used to determine LAA velocity cut‐off. Results Mean patient age was 61.7 ± 10.5; 32% were female. Mean LAA emptying velocity was 47.5 ± 20.2. A total of 103 (40%) patients had recurrence after CA. In the multivariable model, after adjusting for potential confounders, LAA emptying velocity of ≥52.3 was associated with decreased AF recurrence postablation (odds ratio [OR]: 0.55; 95% confidence interval [CI]: 0.31–0.97; p = .03*). There were 190 (73%) patients in normal sinus rhythm during TEE and CA, and sensitivity analysis of these patients showed that LAA velocity ≥52.3 remained associated with decreased AF recurrence (OR: 0.35; 95% CI: 0.15–0.82; p = .01*). Conclusion LAA emptying velocity measured during preprocedural TEE can serve as a predictor of AF recurrence in patients undergoing CA.

Impact of pre‐ablation left appendage flow velocities on long term recurrence of catheter ablation for paroxysmal atrial fibrillation

“…Most previous studies investigating the association between LAA flow velocity and AF recurrence after radiofrequency catheter ablation (CA) focused on persistent AF or all types of AF patients, and many had a small sample size with limited follow‐up duration 7,13–18 . In contrast, our prospective study measured LAAeV and LAAfV on transesophageal echocardiography (TEE) before ablation for consecutive patients with PAF, which could avoid selection bias.…”

“…A previous study found that high LAA flow velocity identifies AF lasting >48 h and <1 year patients with greater likelihood of remaining in sinus rhythm for 1 year after successful electrical or pharmacologic cardioversion 5 . A few recent studies found that a decrease in LAA flow velocity not only predicts embolic events but is also associated with AF relapse after CA 6–8 . However, the role of LAA flow velocity in predicting long‐term recurrence of AF ablation remains controversial based on limited studies, and another study failed to show the favorable results 9 .…”

“…5 A few recent studies found that a decrease in LAA flow velocity not only predicts embolic events but is also associated with AF relapse after CA. [6][7][8] However, the role of LAA flow velocity in predicting long-term recurrence of AF ablation remains controversial based on limited studies, and another study failed to show the favorable results. 9 The purpose of this study was to clarify the association between LAA flow velocity, including emptying (LAAeV) and filling blood flow velocity (LAAfV), and the long-term recurrence after AF ablation for PAF.…”

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

“…Moreover, LA size increases and LA voltages decrease due to LA remodeling, which are considered the surrogate for LA fibrosis and the significant predictor of AF recurrence after CA ( 45 , 46 ). According to recent research, LAAFV is positively correlated with LA voltage and negatively correlated with LA volume ( 47 , 48 ). As an indicator reflecting LA contractile and reserve function, LAAFV demonstrates the severity of LA functional remodeling, which may occur in the early stage of LA remodeling ( 49 ).…”

Pulmonary vein isolation alone or in combination with substrate modulation after electrical cardioversion failure in patients with persistent atrial fibrillation: The PACIFIC trial: Study design

“…Several parameters have been proposed to select patients who truly require an ablation strategy beyond PVI. [9][10][11][12][13] Unfortunately, none of these parameters have successfully identified these patients so far.…”