Abstract 11031: Left Atrial Appendage Flow Velocity Predicts Recurrence of Atrial Fibrillation After Catheter Ablation
Background: A simple and reliable predictor of the recurrence after catheter ablation of atrial fibrillation (AF) is currently unavailable, though left atrial size, duration of AF, serum BNP level, and CHADS2 score have been reported to be associated with increased risk of the recurrence.
OBJECTIVE: We tested the hypothesis that parameters of atrial functions determined by transesophageal echocardiography (TEE), a routine examination before AF ablation, are usable for prediction of the AF recurrence.
METHODS: One hundred and thirty consecutive patients (66.9% paroxysmal AF, 58.3±10.2 (SD) years old, 78.5% male) who had undergone first-time catheter ablation at our institute between January 2009 and July 2012 were retrospectively examined. Multivariate Cox proportional hazards regression analysis was used to determine whether recurrence of AF is predicted by any of demographic parameters, blood pressure, parameters of serum chemistry, medications, device for procedures and/or parameters of TEE.
Result: The number of ablation procedures per patient was 1.25±0.47 (ranging 1 to 3). During follow-up of 717.0±398.7 days after the first procedure, recurrence rates were 33.9% and 47.5% at 1 and 2 years, respectively. During this period, use of irrigation catheter was negative (HR: 0.06, p<0.0001) and use of verapamil on discharge was positive (HR: 2.76, p=0.0247) predictors of the recurrence. Recurrence rates after the last ablation procedure was 18.4% and 29.3% at 1 and 2 years, respectively, and left atrial appendage emptying flow velocity (LAAEV) in TEE independently predicted the recurrence (HR: 5.25, p=0.0012). ROC analysis indicated that optimal cutoff value of LAAEV is 0.51 m/s, of which sensitivity and specificity were 76.7% and 55.3%, respectively. Kaplan-Meier curves indicated that patients with <0.51 m/s of LAAEV had higher recurrence rates than the others at 1 and 2 years after the procedure (28.9% vs. 8.8% and 48.0% vs. 28.9%, respectively, p=0.0008).
CONCLUSION: Reduced LAAEV is a novel predictor of recurrence of AF after catheter ablation, which may reflect progressed atrial remodeling. Factors that reduce LAAEV and strategies to suppress the recurrence in patients with reduced LAAEV warrant further investigation.
- © 2013 by American Heart Association, Inc.