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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left atrial appendage-flow velocity predicts cardioversion success in atrial fibrillation
Bahri Akdeniz1, Ozer Badak, Nezihi Bariş
1Department of Cardiology, Dokuz Eylül University School of Medicine, Izmir, Turkey. bahri.akdeniz@deu.edu.tr
Insights
Left atrial appendage (LAA) flow velocity is a key predictor of successful electrical cardioversion in atrial fibrillation patients. Higher LAA flow velocity indicates a greater chance of restoring normal heart rhythm.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Electrical cardioversion aims to restore normal heart rhythm in atrial fibrillation patients.
- Predicting cardioversion success using traditional methods is often limited.
- The role of left atrial appendage (LAA) function in predicting outcomes is not well understood.
Purpose of the Study:
- To investigate the predictive value of LAA function for electrical cardioversion success in atrial fibrillation.
- To determine if LAA peak flow velocity, area, or ejection fraction can predict cardioversion outcomes.
Main Methods:
- A prospective study involving 163 atrial fibrillation patients undergoing electrical cardioversion.
- Transthoracic and transesophageal echocardiography (TEE) were used to assess LAA function before cardioversion.
- LAA peak flow velocity, area, and ejection fraction were measured.
Main Results:
- Cardioversion was successful in 133 patients and unsuccessful in 30.
- Mean LAA peak emptying flow velocity was significantly higher in successful cardioversion cases (0.34 m/sec) compared to unsuccessful ones (0.27 m/sec).
- LAA flow velocity > 0.28 m/sec was identified as an independent predictor of cardioversion success (OR=2.8, p=0.03).
Conclusions:
- LAA flow velocity is a valuable independent predictor of electrical cardioversion success in atrial fibrillation.
- LAA area and ejection fraction did not significantly predict cardioversion outcomes.
- Measuring LAA flow velocity offers crucial information for patient selection and pre-cardioversion assessment.
Abstract:
Restoration of sinus rhythm by electrical cardioversion is a therapeutic option in appropriately selected patients with atrial fibrillation. It is important to determine predictors of electrical cardioversion outcome in patients with atrial fibrillation. Predictive value of clinical and conventional echocardiographic parameters for predicting cardioversion outcome is limited. The role of left atrial appendage (LAA) function, which may reflect left atrial contractile function, for prediction of cardioversion outcome remains unclear. We conducted a single center prospective study to evaluate the role of LAA function for prediction of cardioversion success in patients with atrial fibrillation. One hundred sixty three patients with atrial fibrillation underwent transthoracic and transesophageal echocardiography (TEE) before electrical cardioversion. LAA functions, including LAA peak flow velocity, LAA area and LAA ejection fraction, were examined. Cardioversion was successful in 133 patients and unsuccessful in 30 patients. Mean LAA peak emptying flow velocity was significantly higher in the patients with successful cardioversion than in those with unsuccessful cardioversion (0.34 +/- 0.14 vs 0.27 +/- 0.1 m/sec; p = 0.013). At multivariate logistic regression analysis, only LAA flow velocity (> 0.28 m/sec, odds ratio = 2.8 ; p = 0.03) proved to be an independent predictor of cardioversion success. LAA area (p = 0.18) and LAA ejection fraction (p = 0.52) were not different between successful and unsuccessful cardioversion groups. Therefore, measurement of LAA flow velocity provides valuable information for prediction of cardioversion outcome in patients with atrial fibrillation before TEE guided cardioversion.
