Abstract 13526: Left Atrial Appendage Emptying Velocity is a Predictor of Atrial Fibrillation Recurrence in Patients Undergoing Catheter Ablation

Abstract

Introduction: Low left atrial (LA) voltage is known to predict Atrial Fibrillation (AF) recurrence after catheter ablation (CA); however, its measurement involves invasive electrophysiology study (EPS). Left Atrial Appendage (LAA) emptying velocities are routinely measured during pre-procedural Transesophageal Echocardiography (TEE). We sought to assess the association between LAA velocities and AF recurrence after CA. Hypothesis: Pre-procedural LAA emptying velocity is a predictor of AF recurrence in patients undergoing CA. Methods: A total of 263 consecutive patients who underwent CA for AF between 2014 and 2020 were included. Baseline clinical characteristics and echocardiographic data of the patients were obtained by chart review. LAA emptying velocities were obtained from TEE. LA voltage was obtained during the EPS. Chi-square test and nominal logistic regression were used for statistical analysis. A sensitivity of 80% on the ROC curve was used for determining LAA velocity cut-off. Results: Mean patient age was 60.8±10.9; 34% were female. Mean LAA emptying velocity was 48.0±20.4. Mean average total voltage (Vavg) of LA was 1.58±1.05. There was a significant positive linear correlation between LAA velocity and LA Vavg (p=0.004*). A total of 68 (26%) patients had recurrence after CA. Patients with lower LA Vavg had increased AF recurrence compared to patients with higher LA Vavg (p=0.004*). In the multivariable model, after adjusting for HTN, CAD, HFrEF, and DM, LAA emptying velocity of ≥52.3 was associated with decreased AF recurrence post-ablation (OR 0.31; 95% CI 0.15-0.66; p = 0.002*). There were 190 (73%) patients in normal sinus rhythm during EPS mapping, and sensitivity analysis of these patients showed that LAA velocity ≥52.3 remained associated with decreased AF recurrence (OR 0.35; 95% CI 0.15-0.82; p = 0.01*). Conclusions: LAA emptying velocity measured during pre-procedural TEE can serve as a predictor of AF recurrence in patients undergoing CA.