Clinical value of left atrial appendage flow for prediction of long-term sinus rhythm maintenance in patients with nonvalvular atrial fibrillation

Antonielli, E; Pizzuti, A; Pálinkás, Attila; Tanga, M; Gruber, N; Michelassi, Claudio; Varga, Albert; Bonzano, Alessandro; Gandolfo, Nicola; Halmai, L.; Bassignana, Antonia; Imran, Muhammad Babar; Delnevo, Fabrizio; Csanády, Miklós; Picaño, Eugenio

doi:10.1016/s0735-1097(02)01800-4

Cited by 118 publications

(79 citation statements)

References 27 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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“…[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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“…24 Our finding that 54 (70%) of 77 patients remained in SR after discharge is a reasonable outcome despite the inclusion of patients with a long (>10 years) AF-D (n=11, 14% of all patients), large (≥65 mm) LAd (n=8, 10% of all patients), and low (≤20 cm/s) LAA-V (n=21, 27% of all patients). Long-standing AF, 26-28 a large LA [26][27][28][29][30] (especially, LAd ≥65 mm 29,30 ), and low LAA-V [31][32][33][34][35] have been shown to be negative predictive factors for both the restoration and maintenance of SR. Yuda et al reported that AF-D was significantly longer in patients with a giant LA than those without 29 and it is known that LAA-V is closely related to LA size. 35 Thus, AF-D, LAd, and LAA-V are related.…”

Section: Discussionmentioning

confidence: 99%

Factors Predicting Success in Cryoablation of the Pulmonary Veins in Patients With Chronic Atrial Fibrillation

Isobe

Taniguchi

Kono

et al. 2004

Circ J

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Clinical value of left atrial appendage flow for prediction of long-term sinus rhythm maintenance in patients with nonvalvular atrial fibrillation

Abstract: In TEE-guided management of nonvalvular AF, high LAA flow velocity identifies patients with greater likelihood to remain in SR for one year after successful CV. Low LAA velocity is of limited value in identifying patients who will relapse into AF.

Cited by 118 publications

References 27 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 Outflow Velocity is Superior to Conventional Criteria for Predicting of Maintenance of Sinus Rhythm After Simple Cryoablation of Pulmonary Vein Orifices

Factors Predicting Success in Cryoablation of the Pulmonary Veins in Patients With Chronic Atrial Fibrillation

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