Inverse Correlation Between Left Atrial Appendage Function and CHA2DS2-VASc Score in Patients with Atrial Flutter

Mei-Yao Wu,Ying-Ying Huang,Kuo-Hung Lin,Kuan-Cheng Chang,Yen-Nien Lin,Jan-Yow Chen,Hung-Pin Wu

doi:10.1038/s41598-019-54505-3

Mei-Yao Wu, Ying-Ying Huang + Show 5 more

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https://doi.org/10.1038/s41598-019-54505-3

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Abstract

Impaired left atrial appendage ejection fraction (LAA-EF) and peak LAA flow velocity (LAA-FV) are associated with high thromboembolic risks in patients with atrial fibrillation (AF). Herein, we examined LAA function among patients with atrial flutter (AFL) stratified by the CHA2DS2-VASc score using transesophageal echocardiography (TEE). Of 231 consecutive patients with typical AFL, 84 who fulfilled the inclusion criteria were enrolled. Among them, 57 had ongoing AFL and were divided into the isolated AFL (n = 38) and AFL with paroxysmal AF (PAF) (n = 19) groups, depending on whether they had sporadic AF before TEE. The remaining 27 patients with spontaneous sinus rhythm during TEE were designated as controls. Both the LAA-FV (31.9 cm/s vs. 51.5 cm/s, P = 0.004) and LAA-EF (28.4% vs. 36.5%, P = 0.024) measured during AFL were significantly lower in the AFL + PAF group than in the isolated AFL group. Significant inverse correlations between the CHA2DS2-VASc score and LAA-EF were identified in the AFL (P = 0.008) and AFL + PAF (P = 0.032) groups. We observed progressive LAA dysfunction in patients with AFL + PAF compared with that in patients with isolated AFL, and the LAA-EF was inversely correlated with the CHA2DS2-VASc score in these patients. Our findings may have implications on the application of thromboprophylactic therapy in patients with AFL.

Highlights

Atrial flutter (AFL) is characterized as an organized atrial rhythm with an atrial rate between 250 and 350 beats/ minute
Among 231 patients who received radiofrequency catheter ablation (RFCA) for inferior vena cava-tricuspid annulus (IVC-TA)-dependent atrial flutter (AFL), 154 patients underwent transesophageal echocardiography (TEE) examination 1 day (IQR: 0−3 days) prior to RFCA (Fig. 1)
After excluding patients who met the exclusion criteria: atrial fibrillation (AF) rhythm during TEE examination (n = 37), presence of mitral stenosis or prosthetic valves (n = 11), ECG documentation of ≥3 episodes of AF before TEE examination (n = 7), and active cancer treatment (n = 1), a total of 84 patients constituted the study population for analysis. Of these 84 patients, 57 had ongoing AFL and were further divided into the isolated AFL group (n = 38) and AFL + paroxysmal AF (PAF) group (n = 19); the 27 remaining patients who had spontaneous sinus rhythm (SR) at the time of TEE were designated as controls for comparison

Summary

Introduction

Atrial flutter (AFL) is characterized as an organized atrial rhythm with an atrial rate between 250 and 350 beats/ minute. Patients with AFL are considered to have equivalent thromboembolic risks similar to patients with AF based on limited data[2,3]. These patients, in general, may not be in the same prothrombotic state as those with AF2. Unlike patients with AF, there are relatively fewer data on LAA function and thrombi in relation to the thromboembolic risk in patients with AFL, and some of these data appear contradictory. Cresti et al.[6] showed that the incidence of LAA thrombi and LA SEC in patients with AFL was similar to that in patients with AF, indicating an equivalent thromboembolic risk between patients with AFL and those with AF. To further stratify the risk of systemic thromboembolism in AFL, we examined LAA function among patients with isolated AFL and AFL with sporadic AF using TEE during AFL

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