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Updated: Dec 8, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Predictors for reduced flow velocity in left atrial appendage during sinus rhythm in patients with atrial
Eiji Fukuhara1, Takanao Mine2,3, Hideyuki Kishima1
1Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
Insights
Reduced left atrial appendage flow velocity (LAAFV) during sinus rhythm (SR) in atrial fibrillation (AF) patients is predicted by elevated brain natriuretic peptide (BNP) and larger left atrial volume index (LAVI). This finding impacts anticoagulation decisions post-catheter ablation.
Area of Science:
- Cardiology
- Electrophysiology
- Echocardiography
Background:
- Discontinuation of anticoagulation after catheter ablation (CA) for atrial fibrillation (AF) is debated.
- Reduced left atrial appendage flow velocity (LAAFV) during AF can cause thrombus, but may also occur during sinus rhythm (SR).
Purpose of the Study:
- To identify predictors of reduced LAAFV during SR in AF patients undergoing CA.
- To assess the relationship between clinical factors, echocardiographic parameters, and LAAFV during SR.
Main Methods:
- Transesophageal echocardiography (TEE) was used to measure LAAFV in 392 AF patients in SR before CA.
- Clinical data, transthoracic echocardiography, and blood samples (including BNP) were collected.
- Reduced LAAFV was defined as <35 cm/s.
Main Results:
- 18% of patients (72/392) had reduced LAAFV during SR.
- Reduced LAAFV was associated with non-paroxysmal AF, elevated BNP, heart failure, higher CHADS2/CHA2DS2-VASc scores, no beta-blockers, increased LAVI, elevated E/e', reduced LVEF, and LVH.
- Multivariate analysis identified elevated BNP and LAVI as independent predictors of reduced LAAFV during SR.
Conclusions:
- Elevated brain natriuretic peptide (BNP) levels and large left atrial volume index (LAVI) are significant predictors of decreased left atrial appendage flow velocity (LAAFV) during sinus rhythm (SR) in patients with atrial fibrillation (AF).
- These findings may inform decisions regarding anticoagulation therapy post-catheter ablation.
Abstract:
Discontinuation of anticoagulation therapy after catheter ablation (CA) for atrial fibrillation (AF) remains controversial. While decreased left atrial appendage flow velocity (LAAFV) during AF leads to left atrial appendage thrombus and embolic events, some AF patients show decreased LAAFV even during sinus rhythm (SR). We studied 392 patients (256 males, 68 ± 10 years) who exhibited SR during transesophageal echocardiography (TEE) before CA for AF. Clinical factors, transthoracic echocardiography, and blood samples were obtained before TEE. Reduced LAAFV was defined as < 35 cm/s of LAAFV. Reduced LAAFV was observed in 72/392 patients (18%). Reduced LAAFV was significantly associated with high prevalence of non-paroxysmal AF, elevated brain natriuretic peptide (BNP), prior heart failure, high CHADS2 score, high CHA2DS2-VASc score, no beta blocker administration, increased left atrial volume index (LAVI), elevated E/e' ratio, reduced left ventricular ejection fraction and high prevalence of left ventricular hypertrophy. On multivariate analysis, BNP (P = 0.0005, OR 1.045 for each 10 pg/ml increase in BNP, 95% CI 1.018-1.073) and LAVI (P = 0.0045, OR 1.044 for each 1 increase in LAVI, 95% CI 1.013-1.077) were associated with decreased LAAFV. The elevated BNP levels and large LAVI predict decreased LAAFV during SR in patients with AF.
