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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Prognostic implication of the left atrial appendage mechanical reserve after cardioversion of atrial fibrillation
Mi Young Park1, Sung Hee Shin, Woong Jin Oh
1Department of Cardiology, Sejong General Hospital, 126-1, 5ka Anamdong,Sungbuk-ku, Seoul 136-705, Korea. wjshimmd@unitel.co.kr
Insights
Left atrial appendage (LAA) mechanical reserve, assessed after cardioversion for atrial fibrillation (AF), predicts long-term sinus rhythm maintenance. Enhanced LAA function indicates a better prognosis for sustained rhythm control.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Echocardiography
Background:
- Atrial fibrillation (AF) recurrence after cardioversion (CV) is common.
- The prognostic value of left atrial appendage (LAA) mechanical function post-CV requires further elucidation.
Purpose of the Study:
- To assess the long-term prognostic implication of LAA mechanical reserve after electrical cardioversion in patients with AF.
- To identify predictors for maintaining sinus rhythm (SR) after AF cardioversion.
Main Methods:
- Transesophageal echocardiography (TEE) measured LAA emptying and filling velocities in 53 successfully cardioverted AF patients.
- Measurements were taken pre-CV, immediately post-CV, and with isoproterenol infusion, with follow-up at 1 year.
- A prediction model was developed using LAA mechanical reserve and E/A ratio.
Main Results:
- A greater peak increase in LAA emptying velocity (LAAEV) with isoproterenol post-CV predicted SR maintenance.
- Multivariate analysis identified peak LAAEV increase as an independent predictor for SR (OR 1.044, p=0.0033).
- A prediction model combining peak LAAEV increase and post-CV E/A ratio achieved 69.8% accuracy for SR maintenance.
Conclusions:
- LAA mechanical reserve is a valid and important factor for maintaining sinus rhythm after cardioversion for atrial fibrillation.
- This study provides a method to evaluate LAA mechanical reserve, aiding in predicting long-term outcomes.
Background:
This study aimed to demonstrate the long-term prognostic implication of left atrial appendage (LAA) mechanical reserve determined after electrical cardioversion (CV) of atrial fibrillation (AF).
Methods And Results:
53 successfully cardioverted chronic AF patients were studied (M/F =40/13, mean age =59+/-3). LAA emptying velocity (LAAEV) and filling velocity (LAAFV) were measured using transesophageal echocardiography (TEE) before cardioversion, immediately after CV, and with isoproterenol infusion. TEE was done at baseline, 1 month, 3-6 months, and 1 year after CV. At 1-year follow-up, 27 patients remained in sinus rhythm (SR, Group 1) and 26 patients showed AF recurrence (Group 2). Baseline clinical and echocardiographic findings were similar between the 2 groups. Immediately after CV, LAAEV and LAAFV decreased similarly in both groups. With isoproterenol infusion, the increase of LAAEV was greater in group 1 than in group 2. Multivariate analysis revealed that the peak increase of LAAEV after isoproterenol infusion was an independent predictor for SR maintenance (odds ratio 1.044, 95% confidence interval 1.014 to 1.075; p=0.0033). Prediction model consisting of the peak increase of LAAEV (>34.4 cm/s) and E/A ratio immediately after CV (<2.5) showed a good predictability for SR maintenance (correct ratio 69.8%).
Conclusion:
This study presents a valid evaluation method for LAA mechanical reserve and demonstrated that LAA mechanical reserve is responsible for the maintenance of SR.
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