Value of Left Atrial Appendage Function Measured by Transesophageal Echocardiography for Prediction of Atrial Fibrillation Recurrence after Radiofrequency Catheter Ablation

Istrătoaie, Sabina; Vesa, Ştefan Cristian; Cismaru, Gabriel; Pop, Dana; Roşu, Radu; Puiu, Mihai; Pepine, Diana; Ciobanu, Cristina; Minciună, Ioan Alexandru; Simu, Gelu; Zdrenghea, Dumitru; Buzoianu, Anca Dana

doi:10.3390/diagnostics11081465

Cited by 14 publications

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References 22 publications

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“…Table 1 displayed the study characteristics of 16 included studies, comprising 9 ( 12 , 15 , 18 , 20 , 21 , 23 – 25 , 27 ) prospective studies and 7 ( 13 , 14 , 16 , 17 , 19 , 22 , 26 ) retrospective studies. Six studies ( 19 , 22 – 25 , 27 ) were conducted in China, 4 studies ( 15 , 16 , 20 , 21 ) in Japan, 2 studies ( 14 , 17 ) in Hungary, 1 study ( 26 ) in South Korea, 1 study ( 13 ) in Poland, 1 study ( 12 ) in Türkiye, and 1 study ( 18 ) in Romania. Sixteen studies with 5,006 AF patients after CA (1,479 patients with AF recurrence, 3,527 without AF recurrence) were included, and the proportion of AF patients with recurrence ranged from 24.1 to 41.5%.…”

Section: Resultsmentioning

confidence: 99%

“…The mean age ranged from 54.6 ± 10.4 to 67.5 ± 7.5 years, and the median follow-up time varied from 6 to 48 months. Nine ( 12 – 15 , 17 , 18 , 22 , 23 , 25 ) studies performed circumferential pulmonary vein isolation (CPVI) alone, whereas 7 ( 16 , 19 – 21 , 24 , 26 , 27 ) studies conducted additional linear ablations. The LAAFV, which refers to the peak flow emptying velocity of the left atrial appendage at late diastole, was measured by transthoracic echocardiography (TEE) in all selected research.…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies ( 12 , 13 , 15 , 18 , 20 , 22 , 26 ) defined LAAFV as categorical variables. The pooled analysis showed that lower LAAFV was associated with an increased risk of AF recurrence after CA [OR:2.28, 95% CI: 1.46 to 3.57, P < 0.01; I 2 = 93.4% Figure 4 ].…”

Section: Resultsmentioning

confidence: 99%

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

Chen

Shi

et al. 2022

Front. Cardiovasc. Med.

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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].

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Chen

Shi

et al. 2022

Front. Cardiovasc. Med.

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“…Kanda and colleagues 8 studied 53 patients with persistent AF and found that low LAAeV velocity was associated with AF recurrence postablation. Istratoaie and colleagues 9 found that low LAAeV was an independent predictor of AF recurrence within 1 year after ablation. Similarly, Kielbasa and colleagues 10 showed that LAAeV was an independent predictor of AF recurrence in 417 patients with paroxysmal AF who underwent cryoballoon‐based pulmonary vein isolation.…”

Section: La Appendage Emptying Velocity As a Predictor Of Af Recurren...mentioning

confidence: 97%

Left atrial appendage emptying velocity as a predictor of recurrence of atrial fibrillation post‐ablation

Ezzeddine

DeSimone

2022

Cardiovasc electrophysiol

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One of the major problems facing both patients and electrophysiologists in catheter ablation (CA) of atrial fibrillation (AF) is the limited objective data to determine abnormal atrial substrate preprocedurally. Clinical trials and observational studies have tremendous heterogeneity, and an individualized assessment to inform patients about ablation success rates and the potential need for antiarrhythmic drugs and/or redo ablation can be challenging. Certain risk factors such as obesity, sleep apnea, and diabetes, tests such as an electrocardiogram to assess P-wave amplitude and duration, and echocardiography to assess left atrial (LA) size can provide some insight into the "health" of the LA. However, it is not until after a transseptal puncture to measure LA pressures and perform a voltage map of the LA that we can truly appreciate the presence of abnormal atrial substrate.

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“…Numerous studies have been conducted to assess the causes and mechanisms of AF recurrence as well as contributing risk factors. Major risk factors for recurrence include the type of AF (persistent or paroxysmal), left ventricle dysfunction, left atrial enlargement, diabetes, and obstructive sleep apnea 4,5 . Research to determine more accurate risk factors that can predict recurrence of AF post CA is ongoing.…”

Section: Introductionmentioning

confidence: 99%

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

Thotamgari¹,

Sheth²,

Ahmad³

et al. 2022

Cardiovasc electrophysiol

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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.

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Value of Left Atrial Appendage Function Measured by Transesophageal Echocardiography for Prediction of Atrial Fibrillation Recurrence after Radiofrequency Catheter Ablation

Cited by 14 publications

References 22 publications

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

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

Left atrial appendage emptying velocity as a predictor of recurrence of atrial fibrillation post‐ablation

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

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