Left Atrial Appendage Emptying Velocity Research Articles

The association between left atrial appendage emptying velocity and atrial fibrillation recurrence after radiofrequency catheter ablation in patients with early persistent atrial fibrillation

ObjectiveIn the present study, we aimed to explore the association between left atrial appendage emptying velocity (LAAEV) measured by transesophageal echocardiography and atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA) in patients with early persistent atrial fibrillation (PeAF).MethodsWe retrospectively analyzed patients with early PeAF who underwent their initial ablation procedure. The echocardiographic and clinical data of the enrolled patients were collected and recorded prior to the operation. Following adjustment for confounding factors, we investigated the relationship between the LAAEV and AF recurrence in patients with early PeAF after radiofrequency ablation.ResultsThe proportions of AF recurrence in the low, medium, and high LAAEV groups were 48.8%, 16.0%, and 13.1%, respectively. After adjusting for potential confounding factors, we observed a gradual decrease in the risk of AF recurrence with increasing LAAEV (odds ratio: 0.882, 95% confidence interval: 0.842—0.924, p<0.001). This trend was statistically significant (p<0.001), particularly when comparing the high and low LAAEV groups (odds ratio: 0.033, 95% confidence interval: 0.009―0.116, p<0.001). Curve fitting analysis demonstrated an approximate negative linear association between LAAEV and the probability of AF recurrence.ConclusionsAmong patients with early PeAF who successfully underwent their first RFCA, we found that the LAAEV within 24 h before the procedure was independently correlated with the risk of AF recurrence. Notably, this association was negative, indicating that higher LAAEV was associated with a lower risk of AF recurrence.

Assessing Left Atrial Appendage Functions by Transesophageal Echocardiography and Speckle Tracking Imaging to Predict Recurring Atrial Fibrillation Post-Radiofrequency Catheter Ablation.

To predict recurring atrial fibrillation (AF) following radiofrequency catheter ablation by assessing the attributes of the left atrium and the left atrial (LA) appendage (LAA) using transesophageal echocardiography (TEE) and speckle tracking imaging. The structural and functional indices of the LA and LAA of 80 patients with AF who underwent preoperative transthoracic echocardiography and TEE were measured. Recurrence was recorded postoperatively at 3, 6, and 12 months. The independent determinants of recurring AF were identified by logistic regression, and their optimum cutoff values, sensitivity, and specificity were estimated from the receiver operating characteristic (ROC) curves. The recurrent and nonrecurrent groups comprised 17 and 63 patients, respectively. The LA internal diameter, LA end-diastolic and end-systolic volumes, LAA length, diameter and area of the opening of the LAA, and LAA end-diastolic volume were higher in the recurrent group. The LA strain in the reservoir phase, the ejection fraction and filling velocity of the LAA, the LAA emptying velocity (LAAeV), and the LAA strain (LAAS) reduced considerably. Multifactorial regression analyses demonstrated that the LAAeV and LAAS were independent determinants of recurring AF. ROC curve analysis revealed that the LAAeV and LAAS predicted postoperative recurrence at 34.5cm/s (area under the curve [AUC]: 0.954, sensitivity: 94.1%, and specificity: 92.1%) and 11.61% (AUC: 0.925, sensitivity: 82.4%, and specificity: 95.2%), respectively, while the AUC, sensitivity, and specificity of the combined predictors (LAAeV+LAAS) were 0.978, 94.1%, and 93.7%, respectively. The LAAeV and LAAS independently influenced the postoperative recurrence of AF.

Predictors of left atrial appendage emptying velocity: Derivation and validation of CHIRP3(M-1) score

BackgroundAtrial fibrillation (AF) leads to impaired left atrial appendage contractility, increasing the risk of thromboembolic stroke. The left atrial appendage emptying velocity (LAAev) measured on transesophageal echocardiogram (TEE) is a marker of increased thromboembolic risk. ObjectivesThe purpose of this study was to evaluate predictors of reduced LAAev for identifying individuals at increased risk for cardioembolic stroke. MethodsThis was a single-center retrospective review of TEEs and clinical charts. Predictors of LAAev <30 cm/s were identified using logistic regression. A risk prediction model was created using stepwise selection in a derivation set (n = 695) and separately tested in a validated set (n = 300). ResultsWe included TEEs on 995 patients (age 71.3±12.7 years; female 38.1%; history of AF 82.1%; in AF at evaluation 27.7%; CHA2DS2-VASc score 4.1 ± 1.9; LAAev 41.6 ± 21.0 cm/s). Significant multivariable predictors of LAAev <30 cm/s in derivation set were used to create the CHIRP3M-1 score containing 8 variables: Coronary artery disease (1), congestive Heart failure (1), Increased left atrial volume index ≥42 mL/m2 (1), current Rhythm AF (1), Paroxysmal AF (2), Persistent AF (3), longstanding Persistent/permanent AF (4), and greater than moderate Mitral regurgitation (-1). In the validation set, as compared to intermediate scores (3–4), those with low scores (≤2) and high scores (≥5) had odds ratios for LAAev <30 cm/s of 0.41 (0.21, 0.78, P = .007) and 2.58 (95% confidence interval 1.45–4.61, P = .001), respectively. ConclusionWe developed and validated a novel risk stratification system to predict reduced LAAev using clinical and echocardiographic variables. This may help refine the stratification of cardioembolic stroke risk.

Influencing factors and predictive model for left atrial appendage emptying velocity in nonvalvular AF patients.

Atrial fibrillation (AF) is the most common cardiac arrhythmia, significantly increasing the risk of death and stroke. The left atrial appendage (LAA) plays a crucial role in the development of AF. Reduced left atrial appendage emptying velocity (LAAEV) is an important indicator of nonvalvular AF, associated with thrombosis and recurrence after catheter ablation. This study aims to identify factors influencing LAAEV and construct a predictive model for LAAEV in nonvalvular AF patients. This retrospective cohort study included 1,048 nonvalvular AF patients hospitalized at the Second Hospital of Hebei Medical University from January 1, 2015, to December 31, 2021. Patients underwent transthoracic and transesophageal echocardiography and had complete laboratory data. Statistical analyses included binary logistic regression and multiple linear regression to identify independent predictors of reduced LAAEV and construct a predictive model. Patients were divided into two groups: reduced LAAEV (<40 cm/s) and normal LAAEV (≥40 cm/s). The reduced LAAEV group included 457 patients (43.61%), with significant differences in age, gender, alcohol consumption, heart failure (HF), ischemic stroke, AF type, resting heart rate, CHA2DS2-VASc score, serum creatinine (SCR), serum uric acid (SUA), estimated glomerular filtration rate (eGFR), glycated hemoglobin (HbA1C), β2 macroglobulin (B2M), left atrial diameter (LAD), and left ventricular ejection fraction (LVEF) compared to the normal LAAEV group. Logistic regression analysis identified age (OR 0.974, 95% CI 0.951-0.997, P = 0.028), HF (OR 0.637, 95% CI 0.427-0.949, P = 0.027), AF type [Persistent AF vs. PAF (OR 0.063, 95% CI 0.041-0.095, P = 0) Long-standing Persistent AF vs. PAF (OR 0.077, 95% CI 0.043-0.139, P = 0)], LAD (OR 0.872, 95% CI 0.836-0.91, P < 0.001), and LVEF (OR 1.057, 95% CI 1.027-1.089, P = 0) as independent predictors of reduced LAAEV. Multiple linear regression analysis included age, AF type, LAD, and LVEF in the final predictive model, explaining 43.5% of the variance in LAAEV (adjusted R² = 0.435). Age, HF, type of AF, LAD, and LVEF are independent predictors of reduced LAAEV. The predictive model (LAAEV = 96.567-15.940 × AFtype-1.309 × LAD-0.18 × Age + 37.069 × LVEF) demonstrates good predictive value, aiding in the initial assessment and management of nonvalvular AF patients.

Morphology and location of thrombus and sludge in patients with non-valvular atrial fibrillation

BackgroundStroke and thromboembolism in nonvalvular atrial fibrillation (NVAF) primarily arise from thrombi or sludge in the left atrial appendage (LAA). Comprehensive insight into the characteristics of these formations is essential for effective risk assessment and management.MethodsWe conducted a single-center retrospective observational of 176 consecutive NVAF patients with confirmed atrial/appendage thrombus or sludge determined by a pre-ablation transesophageal echocardiogram (TEE) from December 2017 to April 2019. We obtained clinical and echocardiographic characteristics, including left atrial appendage emptying velocity (LAAeV) and filling velocity (LAAfV). Data analysis focused on identifying the morphology and location of thrombus or sludge. Patients were divided into the solid thrombus and sludge groups, and the correlation between clinical and echocardiographic variables and thrombotic status was analyzed.ResultsMorphological classification: In total, thrombi were identified in 78 patients, including 71 (40.3%) mass and 7 (4.0%) lamellar, while sludge was noted in 98 (55.7%). Location classification: 92.3% (72/78) of patients had thrombus confined to the LAA; 3.8% (3/78) had both LA and LAA involvement; 2.7% (2/78) had LA, LAA and RAA extended into the RA, the remained 1.2%(1/78) was isolated to RAA. 98.0% (96/98) of patients had sludge confined to the LAA; the remaining 2.0% (2/98) were present in the atrial septal aneurysm, which protrusion of interatrial septum into the RA. The thrombus and sludge groups showed low LAAeV (19.43 ± 9.59 cm/s) or LAAfV (17.40 ± 10.09 cm/s). Only LA dimension ≥ 40 mm was independently associated with the thrombus state in the multivariable model.ConclusionThis cohort study identified rare thrombus morphology and systematically summarized the classification of thrombus morphology. The distribution of thrombus and sludge outside limited to LAA was updated, including bilateral atrial and appendage involvement and rare atrial septal aneurysm sludge. LAAeV and LAAfV were of limited value in distinguishing solid thrombus from sludge.Clinical Trial NumberChiCTR-OCH-13,003,729.

A Predictive Model for Recurrence of Atrial Fibrillation Based on P-Wave Duration in Patients with Early Persistent Atrial Fibrillation Who Underwent Radiofrequency Catheter Ablation

Purpose: To construct a predictive model for the recurrence of atrial fibrillation (AF) based on P-wave duration (PWD) in patients with early persistent AF (PeAF) who underwent radiofrequency catheter ablation (RFCA), with the aim of helping clinicians accurately adjust clinical strategies. Methods: Data from patients with early PeAF, who were admitted to the Department of Cardiology at the authors' hospital were collected. Based on predefined inclusion and exclusion criteria, only those who successfully underwent RFCA for the first time were included in the analysis. Pre- and postoperative clinical, echocardiographic, and electrocardiographic data were collected and recorded. Multivariate logistic regression was used to construct a predictive model for AF recurrence based on PWD. The predictive efficacy of each continuous variable and the predictive model were compared using the area under the receiver operating characteristic (ROC) curve. The corresponding nomogram for the predictive model was constructed. Interaction tests were performed to evaluate the predictive efficacy of the model for AF recurrence. Results: A total of 237 patients were enrolled and divided into two groups: recurrence (n = 59); and sinus rhythm (n = 178). PWD was greater and left atrial appendage emptying velocity (LAAV) was lower in the recurrence group; these differences were statistically significant (p &lt; 0.001). The ROC curve for univariate prediction of AF recurrence revealed that the area under the ROC curve (AUC) for PWD and LAAV were 0.7912 and 0.7713, respectively, which were greater than those of other continuous variables. Compared with PWD alone, the multivariate predictive model containing PWD, left ventricular ejection fraction, and LAAV demonstrated no statistically significant difference in AUC (p = 0.0553) but improved the prediction efficiency of correctly reclassifying recurrence rates, net reclassification improvement 14.13% (95% confidence interval: 0.19–28.07%; p = 0.0469). The interaction effect did not significantly alter the effectiveness of the predictive models. Conclusions: The multivariate model based on PWD measured after RFCA demonstrated better predictive efficacy than the univariate model in patients with early PeAF. These results may contribute to evidence supporting the formulation of personalised treatments for patients with AF.

Clinical Implication of Left Atrial Appendage Emptying Velocity in Thoracoscopic Ablation of Atrial Fibrillation.

There are limited data about predictors of atrial fibrillation (AF) recurrence after totally thoracoscopic ablation (TTA). This study investigated the clinical implication of left atrial appendage emptying velocity (LAAV) in patients undergoing TTA.Methods and Results: Patients who underwent TTA between 2012 and 2015 at a tertiary hospital were prospectively enrolled in this study. LAAV was measured and averaged over five heart beats from preoperative transesophageal echocardiography. The primary outcome was a freedom from recurrent AF or atrial flutter (AFL) detected on 24-h Holter monitoring or an electrocardiogram over a 3-year period after TTA. In all, 129 patients were eligible for analysis in this study. The mean (±SD) patient age was 54.4±8.8 years, and 95.3% were male. During the 3 years after TTA, the overall event-free survival rate was 65.3%. LAAV was an independent predictor of recurrent AF/AFL during the 3-year period after TTA (per 1-cm/s increase, adjusted hazard ratio [aHR] 0.95; 95% confidence interval [CI] 0.91-0.99; P=0.016). Event-free survival was significantly lower among patients with a low LAAV (<20 cm/s; n=21) compared with those with a normal (≥40 cm/s; n=38; aHR 6.11; 95% CI 1.42-26.15; P=0.015) or intermediate (LAAV ≥20 and <40 cm/s; n=70; aHR 2.74, 95% CI 1.29-5.83; P=0.009) LAAV. In patients with AF, LAAV was significantly associated with the risk of long-term recurrence of AF after TTA.

Abstract 17844: Association of Left Atrial Appendage Emptying Velocity With Type of Atrial Fibrillation

Introduction: Left atrial appendage emptying velocity (LAAev) is a surrogate for propensity of LAA thrombus and cardioembolic stroke. While atrial fibrillation (AF) is a known cause of reduced LAAev, relationship between type of AF and LAAev is unclear. Hypothesis: Long-standing persistent/permanent (LSP) AF is associated with reduced LAAev compared to paroxysmal/persistent AF. Methods: We searched transesophageal echocardiogram (TEE) reports of unique individuals from 2016-2022 at the University of Kansas Medical Center. LAAev was obtained from Doppler TEE images. Type of AF and other variables were extracted from medical charts. Association of AF type with LAAev was assessed using univariate and multivariate linear regressions. The multivariate model including all significant univariate predictors comprised age, sex, hypertension, coronary artery disease, peripheral arterial disease, history of venous thromboembolism, left atrial size, mitral regurgitation, left ventricular ejection fraction, rhythm during TEE, general anesthesia, eGFR, and platelet count. Results: Our study comprised 995 patients (female 38.1%, age 71.3±12.7 yr, white 89.3%) of whom 817 (82.1%) had history of AF (43.6% paroxysmal, 21.7% persistent, 16.8% LSP. Among the 817 patients with AF, history of LSP AF was associated with reduced LAAev both in univariate (β=-8.65±1.70 cm/s, p&lt;0.0001) and multivariate (β=-3.77±1.98 cm/s; p=0.05) analyses. Conclusion: Even though CHA 2 DS 2 VASc score does not incorporate type of AF, we found LSP AF to be an independent marker for reduced LAAev. History of LSP AF should be considered in future AF-related stroke risk stratification models.

Abstract 18187: Scoring System to Predict Reduced Left Atrial Appendage Emptying Velocity

Introduction: Left atrial appendage emptying velocity (LAAev) as assessed on transesophageal echocardiography (TEE) is a surrogate for propensity for LAA thrombus and cardioembolic stroke. Identifying patients with decreased LAAev is important for risk stratification. CHA 2 DS 2 -VASc score is used to stratify stroke risk in atrial fibrillation (AF) but does not incorporate rhythm, type of atrial fibrillation or transthoracic echocardiography (TTE). Objective: To create a composite scoring system using clinical and TTE variables to predict reduced LAAev. Methods: We searched TEE reports of unique patients from 2016-2022 at the University of Kansas Medical Center. Additional information was extracted from review of TEE imaging, TTE reports and detailed medical chart review. Significant univariate predictors of reduced LAAev (&lt;30 cm/s) were added to a stepwise selection multivariable logistic regression model with significance level for entry and stay 0.15. Based on their respective odds ratios, selected variables were assigned different point values to create a risk score. Results: We included 995 patients (women 38.1% men, age 71.3±12.7 yrs, white 89.3%, LAAev 41.6±21.0 cm/s). The derived score includes different points assigned for long-standing persistent/permanent AF, persistent AF, paroxysmal AF, current rhythm AF, coronary artery disease, congestive heart failure, female sex, age ≥70 yrs and negative points for &gt;moderate mitral regurgitation; categorized into high, intermediate and low risk (see Figure). The rate of reduced LAAev &lt;30 cm/s was respectively 55.7%, 35.2% and 9.0%. Conclusions: Our scoring system was able to stratify risk of reduced LAAev and needs to be validated in independent datasets.

Left atrial appendage doppler velocity as a predictor of recurrence of atrial fibrillation after transesophageal echocardiogram guided electrical cardioversion.

There is a paucity of data on average left atrial appendage emptying velocity (LAAV) measured by doppler during transesophageal echocardiogram (TEE) being able to predict the risk of AF recurrence after electrical cardioversion (ECV). Using electronic medical records from a community hospital, retrospective study was conducted after identifying all patients that received TEE-guided ECV. Data pertaining to LAAV, AF recurrence, and variables were obtained and analyzed. Out of 625 patients receiving TEE-guided ECV, 94 were excluded, and 51 did not convert to sinus rhythm. 480 patients had a successful ECV; out of these, 201 (41.87%) and 243 (50.62%) had a recurrence of atrial fibrillation at the end of 1month and 3months, respectively. Low LAAV (<=30cm/s) was independently associated with an increased risk of AF recurrence at the end of 1month (aOR 2.37, 95CI 1.5-3.73; p<0.001) and 3months (aOR 2.51, 95CI 1.59-3.96; p<0.001) after TEE-guided ECV. Low LAAV is associated with a high risk of AF recurrence. Identifying a specific subgroup of individuals at high risk of AF recurrence with the help of pre-ECV LAAV will facilitate the early institution of alternate treatment strategies and the plan for additional therapies.

Impact of pre-ablation left appendage flow velocities on long term recurrence of catheter ablation for paroxysmal atrial fibrillation.

Despite undergoing a single ablation, many patients with paroxysmal atrial fibrillation (PAF) experience a gradually increasing recurrence rate. This study aims to examine the relationship between left atrial appendage emptying velocity (LAAeV) and filling velocity (LAAfV) profiles and 3-year recurrence of AF after ablation. We conducted a prospective study of 658 consecutive PAF patients who underwent their first ablation between January 2018 and December 2019. We collected the clinical and echocardiographic characteristics of the patients. LAAeV and LAAfV were obtained from a transesophageal echocardiogram (TEE) before catheter ablation. Patients were followed at regular intervals to monitor for the primary outcome of AF recurrence. After a median follow-up period of 35.3 months (range, 10.7-36.3), 288 patients (43.8%) experienced AF recurrence after catheter ablation. Patients who experienced AF recurrence had decreased LAAeV and LAAfV (LAAeV: 56.5±21.2vs. 59.6±20.7cm/s, p=.052; LAAfV: 47.5±17.9vs. 51.7±18.2, p=.003). Kaplan-Meier analysis showed that patients in the low LAAeV(<55cm/s) group had a poorer event-free survival rate than those in the high LAAeV (≥55cm/s) group (log-rank p=.012). Patients with LAAfV<48cm/s had a significantly higher risk of AF recurrence than those with LAAfV ≥48cm/s (log-rank p=.003). In the multivariable model, low LAAfV pre-ablation in TEE-guided was significantly independently associated with 3-year recurrence after single radiofrequency ablation in patients with PAF, along with LA dimension and duration of AF. This study found an independent association between low LAAfV pre-ablation in TEE-guided and 3-year recurrence after single radiofrequency ablation in patients with PAF.

Value of Left Atrial Strain in Predicting Recurrence after Atrial Fibrillation Ablation.

This study tested the relationship between left atrial (LA) function parameters and the results of pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). Consecutive patients undergoing PVI for the first time between 2019 and 2021 were included. Patients underwent radiofrequency ablation using contact force catheters and an electroanatomical system. Follow-up consisted of ambulatory visits/televisits and 7-day Holter monitoring (at 6 and 12 months after ablation). On the day of ablation, all patients underwent transesophageal and transthoracic echocardiography with LA strain analysis. The primary endpoint was atrial tachyarrhythmia recurrence during the follow-up period. Of 221 patients, 22 did not meet the echocardiographic quality criteria, leaving 199 patients. The median follow-up period was 12 months, and 12 patients were lost to follow-up. Recurrences were observed in 67 patients (35.8%) after a mean of 1.06 procedures per patient. The patients were divided into a sinus rhythm (SR, n = 109) group and an AF (n = 90) group based on their cardiac rhythm at the time of echocardiography. In the SR group, univariable analysis showed that LA reservoir strain, LA appendage emptying velocity (LAAV), and LA volume index predicted AF recurrence, with only LAAV being significant in the multivariable analysis. In AF patients, univariable analysis revealed no LA strain parameters predicting AF recurrence.

Reduced Left Atrial Appendage Flow Is Associated With Future Atrial Fibrillation After Cryptogenic Stroke

Hemostasis within the left atrial appendage (LAA) is a common cause of stroke, especially in patients with atrial fibrillation (AF). Although LAA flow provides insights into LAA function, its potential for predicting AF has yet to be established. The aim of this study was to explore whether LAA peak flow velocities early after cryptogenic stroke are associated with future AF on prolonged rhythm monitoring. A total of 110 patients with cryptogenic stroke were consecutively enrolled and underwent LAA pulsed-wave Doppler flow assessment using transesophageal echocardiography within the early poststroke period. Velocity measurements were analyzed offline by an investigator blinded to the results. Prolonged rhythm monitoring was conducted on all participants via 7-day Holter and implantable cardiac monitoring devices, with follow-up conducted over a period of 1.5years to determine the incidence of AF. The end point of AF was defined as irregular supraventricular rhythm with variable RR interval and no detectable P waves lasting ≥30sec during rhythm monitoring. During a median follow-up period of 539 days (interquartile range, 169-857 days), 42 patients (38%) developed AF, with a median time to AF diagnosis of 94 days (interquartile range, 51-487 days). Both LAA filling velocity and LAA emptying velocity (LAAev) were lower in patients with AF (44.3±14.2 and 50.7± 13.3cm/s, respectively) compared with patients without AF (59.8±14.0 and 76.8±17.3cm/sec, respectively; P<.001 for both). LAAev was most strongly associated with future AF, with an area under the receiver operating characteristic curve of 0.88 and an optimal cutoff value of 55cm/sec. Age and mitral regurgitation were independent determinants of reduced LAAev. Impaired LAA peak flow velocities (LAAev<55cm/sec) in patients with cryptogenic stroke are associated with future AF. This may facilitate the selection of appropriate candidates for prolonged rhythm monitoring to improve its diagnostic accuracy and implementation.

Comparison of the Appendicular Emptying Velocity of Left Atrium in patient with moderate versus severe chronic rheumatic mitral stenosis measured by pulsed wave Doppler in Transesophageal echocardiography

Background: Left atrial appendage (LAA) is considered the “most lethal human appendage” as it causes significant mortality and morbidity in chronic rheumatic mitral stenosis patients due to cardiogenic cerebral infract. Presence of LAA dysfunction has been shown to be a strong predictor of thrombus formation and the risk of embolic event, even if no clot is found at the time of initial examination. LAA emptying velocity are measured by trans esophageal echocardiography (TEE) represent as a surrogate marker for left atrial(LA) function .LAA emptying velocities (contraction velocity) &lt; 20cm/s are associated with risk of spontaneous echo contrast(SEC), LAA thrombus, and subsequent cardio embolic events. So early detection of low emptying velocity without SEC or LA thrombus can reduce mortality &amp; morbidity related to cardio embolic stroke and also helps in further management procedure like cardio version etc. So we will compare LAA emptying velocity moderate versus severechronic rheumatic mitral stenosis patients in our population for further attention.&#x0D; Objective: To assess emptying velocity of LAA in patient with moderate versus severe chronic rheumatic mitral stenosis, from a Bangladesh health service perspective.&#x0D; Method: This was a cross sectional study which was conducted in UCC, BSMMU during the period of from February 2019 to September 2019 in Echo lab .&#x0D; Study Procedure: We were enrolled 33 CRHD with MS (moderate to severe) patients who underwent TEE and met inclusion &amp; exclusion criteria. The purpose of the study was explained to each subject &amp; informed written consent was obtained. After getting consent relevant history, physical examination and preprocedural investigation was obtained in predesigned structured data collection sheet. TEE was done with Vivid E9® machine. Pulse wave Doppler was position at the tip of the LAA and then emptying velocity of LAA moderate and severe were compared.&#x0D; Outcome measure: Among 33 patients, 3 patients were excluded due to outlier and inadequate data.. In chronic rheumatic mitral stenosis in moderate versus severe cases average LAA emptying velocities were significantly higher moderate CRHD with MS compare to severe CRHD with MS,(26.57±4.91;31.12±5.04), P=0.018.&#x0D; Conclusion:Appendicular emptying velocity of LAA significantly lower in severe CRHD with MS compare to moderate CRHD with MS and it has temporal relation with MS severity. It can be used as a reliable, simple and sami-invasive tool to early predict severity and prevent complication in CRHD with MS as well as for prophylactic measured taken.&#x0D; University Heart Journal 2022; 18(2): 73-79

Left ventricular longitudinal contraction impacts the left atrial appendage function and the occurrence of thromboembolic events in patients with atrial fibrillation

Abstract Introduction Previous research has revealed a relationship between left ventricular (LV) function and incidence of stroke in atrial fibrillation (AF) but the mechanism remains unknown. Purpose Given that the left atrial appendage (LAA) is located in the vicinity of the LV base we hypothesized that the LV longitudinal contraction has an impact on the LAA function, LAA thrombus (LAAT) formation, and occurrence of ischemic stroke (Figure 1A). The aim of this study was to investigate this phenomenon using transesophageal echocardiography (TEE). Material and methods We included in our study 105 consecutive patients (age 59±11; 55 men) undergoing TEE-guided cardioversion for AF. LV longitudinal function was assessed using the mitral annulus plane systolic excursion (MAPSE). LAA function was evaluated using the LAA emptying velocity (LAAEV) and LAA ejection fraction (LAAEF) (Figure 1B). The presence LAAT and spontaneous echo contrast (SEC) were evaluated as well. Results Our patients had a median CHADS2vasc score = 3 (IQR 2–4), LVEF=50±11%, and MAPSE=7.3±1.7mm. MAPSE showed a positive significant correlation with both LAAEV (r=0.34; p&amp;lt;0.01) and LAAEF (r=0.23; p&amp;lt;0.05) (Figure 2). LVEF correlated significantly with LAAEV (r=0.42, p&amp;lt;0.01), and LAA area (r=−0.34; p&amp;lt;0.05), respectively. Additionally, patients who exhibited SEC had significantly lower LAAEF as well as LAAEV when compared with patients without SEC: 31±12% vs 38±12% P=0.022 and 35±18cm/s vs 49±21cm/s P=0.005. Patients who displayed both SEC and LAAT had wider LAA neck when compared to the rest of the group (21.46±3.96mm vs. 18.23±3.78mm; P=0.021). Logistic regression analysis revealed that MAPSE independently predicted the occurrence of ischemic stroke both in univariate and multivariate models that also included the CHADSvasc2 score. Conclusions LV longitudinal contraction appears to influence LAA function. This relationship could potentially have an impact on occurrence of thromboembolic events in patients with atrial fibrillation. Funding Acknowledgement Type of funding sources: None.

PO-638-04 LOW ATRIAL NATRIURETIC PEPTIDE TO BRAIN NATRIURETIC PEPTIDE RATIO WAS ASSOCIATED WITH LEFT ATRIAL REMODELING AND HOSPITALIZATION DUE TO HEART FAILURE IN PATIENTS WITH ATRIAL FIBRILLATION ABLATION

Deficiency of atrial natriuretic peptide (ANP) is thought to contribute to hemodynamic deterioration in case with advanced atrial remodeling due to atrial fibrillation (AF). However, little is known about the association between plasma ANP level and severity of left atrial remodeling or prognosis of heart failure in patients with AF. The purpose of this study was to investigate the association between ANP and left atrial remodeling or prognosis of heart failure in patients with AF ablation. Three hundred and seventy-three consecutive patients who underwent initial ablation for persistent AF (age, 67 ± 10 years; and females, 97 [26%]) were retrospectively enrolled. Plasma ANP and brain natriuretic peptide (BNP) concentration were measured before the procedure and ANP/BNP ratio was calculated. Left atrial appendage emptying velocity (LAAEV), left atrial low voltage areas (LVAs), and left atrial volume index (LAVI) were used as clinical factors of left atrial remodeling. Median plasma ANP level was 116 (71-178) pg/ml, and median ANP/BNP ratio was 0.65 (0.46-1.00). Plasma ANP levels did not correlated with LAAEV or LVAs. There was significant correlations between ANP/BNP ratio and LAAEV, LVAs, or LAVI. During the 24 months follow-up, freedom from hospitalization due to heart failure was significantly lower in patients with a ANP/BNP ratio ≤ 0.65 than in those with a ANP/BNP ratio > 0.65 (94.3% versus 99.5%, P<0.01). The secretion of ANP relative to BNP decrease along with progression of left atrial remodeling in patients with AF ablation. Additionally, hospitalization due to heart failure frequently occurred in patients with low secretion of ANP relative to BNP.

Incidence and Predictors of Left Atrial Appendage Thrombus before Catheter Ablation of Thrombogenic Arrhythmias.

Introduction: Transesophageal echocardiography (TEE) is routinely performed before catheter ablation of atrial tachyarrhythmias to rule out the presence of left atrial thrombi. However, data to support this practice are inconsistent. Methods: We analyzed consecutive pre-procedural TEE in a high-volume electrophysiology center for the presence of left atrial thrombi and a relevant flow reduction in the left atrial appendage (LAA) defined as LAA sludge or LAA emptying velocity (LAAEV) < 20 cm/s. The possible predictors of reduced flow were recorded and compared in a multivariate logistic regression analysis. Results: 1676 TEE were included (1122 before pulmonary vein isolation, 436 before atrial flutter ablation, 166 before other ablations). 543 patients (32%) were female and 991 (59%) were on DOAC. Nine patients (0.5%) had an LAA thrombus on pre-procedural TEE. Ninety-five further patients (5.7%) had a relevant reduction in LAA flow. The underlying rhythm showed a significant association with the presence of LAA thrombus or reduced LAA flow (p = 0.003). Patients in sinus rhythm and cavotricuspid isthmus-dependent atrial flutter exhibited the lowest risk. Additionally, reduced kidney function was associated with a reduction in LAA flow velocities (p = 0.04). Of note, two LAA thrombi occurred in patients in sinus rhythm and six out of nine patients with an LAA thrombus were on vitamin-K antagonists. Conclusions: LAA thrombus is a rare occurrence before an elective catheter ablation. The underlying rhythm and kidney function may serve as markers of a higher likelihood of significantly reduced LAAEV and LAA thrombus.

The Long-Term Results of Three Catheter Ablation Methods in Patients With Paroxysmal Atrial Fibrillation: A 4-Year Follow-Up Study.

Aims: Catheter ablation of paroxysmal atrial fibrillation (PAF) has been shown to be effective and safe. However, recurrence of PAF varies between 10 and 30% for radiofrequency ablation. There have been no reports comparing long-term recurrence rates following radiofrequency ablation, cryoablation, and three-dimensional guided cryoablation plus radiofrequency ablation. The aim of this study was to observe the long-term recurrence rate of PAF when treated by these three catheter ablation methods, and to explore clinical factors that can potentially predict PAF recurrence following catheter ablation.Methods: There were 238 patients involved in this study, including 106 radiofrequency (RF) ablation cases (RF group), 66 cryoablation cases (Freeze group), and 66 cases treated by three-dimensional guided cryoablation combined with radiofrequency ablation (Freeze-plus-RF group). All patients underwent standardized follow-up. The recurrence rate of atrial fibrillation (AF) in the three groups was calculated. Predictive factors for the recurrence of AF were also investigated.Results: At 48 months (the median follow-up period), the sinus rhythm maintenance rate was 77.4% in the RF group, 72.7% in the Freeze group, and 81.8% in the Freeze-plus-RF group. The maintenance rate of sinus rhythm was highest in the Freeze-plus-RF group, but differences among the three groups were not statistically significant. Further analysis found that the preoperative left atrial appendage emptying velocity (LAAEV) (recurrence vs. no recurrence, 56.58 ± 18.37 vs. 65.59 ± 18.83, respectively, p = 0.003), left atrial (LA) anteroposterior dimension (recurrence vs. no recurrence, 36.56 ± 4.65 vs. 35.00 ± 4.37, respectively; p = 0.028), and LA vertical dimension (recurrence vs. no recurrence, 56.31 ± 6.96 vs. 53.72 ± 6.52, respectively; p = 0.035) were related to postoperative recurrence. Multiple Cox regression analysis showed that only LAAEV was predictive of postoperative recurrence of PAF (hazard ratio: 0.979; 95% confidence interval: 0.961–0.997).Conclusion: Our study found that there was no statistically significant difference in long-term recurrence rates among the RF, Freeze, and Freeze-plus-RF groups. Preoperative LAAEV is an independent predictor of postoperative recurrence of PAF.

Decreased left atrial appendage emptying velocity as a link between atrial fibrillation type, heart failure and older age and the risk of left atrial thrombus in atrial fibrillation.

Decreased left atrial appendage emptying velocity (LAAV) is a known predictor of LAA thrombus in atrial fibrillation (AF). The aim of our study was to identify which of the clinical risk factors for LAA thrombus are associated with decreased LAAV. The study included 1476 consecutive AF patients who underwent transesophageal echocardiography (TEE) before AF direct current cardioversion or ablation in two high-reference cardiology departments. Patients were divided into two groups: 71 (4.8%) patients with LAAV < 20 cm/s and 1405 patients (95%) with LAAV ≥ 20 cm/s. Compared with patients with LAAV ≥ 20 cm/s, those with decreased LAAV were older, more often had non-paroxysmal AF, were burdened with more concomitant diseases (including hypertension, diabetes, vascular disease, and heart failure [HF]) with higher median CHA2 DS2 -VASc score (3 [2-4] vs 2 [1-3], P < .0001), and had lower glomerular filtration rate (GFR). Prevalence of LAA thrombus was higher in patients with decreased LAAV compared with those with LAAV ≥ 20cm/s (20% vs 4.6%, P < .0001). In patients with decreased LAAV, there was no difference in the frequency of LAA thrombus between those treated with VKA and those receiving NOAC, while in patients with LAAV ≥ 20 cm/s a trend was observed towards a benefit with NOAC. In multivariate logistic regression, non-paroxysmal AF, HF and age ≥ 65 years predicted both LAAV < 20 cm/s and LAA thrombus, while GFR < 60 mL/min/1.73 m2 predicted only the presence of LAA thrombus. One in five AF patients with decreased LAAV had LAA thrombus, regardless of the type of OAC. Non-paroxysmal AF, HF and age ≥ 65 years might increase LAA thrombus risk via reduced LAAV.

A new risk model of assessing left atrial appendage thrombus in patients with atrial fibrillation – Using multiple clinical and transesophageal echocardiography parameters

BackgroundsPredicting left atrial appendage thrombus (LAAT) in non-valvular atrial fibrillation (NVAF) patients need more precisely quantified risk models. In this study, we attempted to review the risk markers for LAAT and develop a simple and reliable model for LAAT prediction. MethodsThe study included 307 patients with NVAF who were scheduled for transesophageal echocardiography (TEE) to exclude LAA thrombus before synchronized electrical cardioversion or radiofrequency ablation for atrial fibrillation (AF). We analyzed the relationship between echo, clinical parameters and the presence or absence of LAAT. ResultsA total of 33 patients were found having LAAT (10.7%, 33/307). The age, left atrial appendage emptying velocity (LAAEV), left atrial or left atrial appendage spontaneous echocardiographic contrast (SEC), less than moderate to severe mitral regurgitation (≤mild MR), and left atrial enlargement showed association with LAAT. The multivariate logistic regression analysis revealed that LAAEV, SEC and ≤mild MR were independent risk factors of the LAAT. We used LAAEV ≤ 21.5 cm/s, SEC and ≤mild MR to construct a combined predictive model for LAAT in NVAF patients (the area under receiver operator characteristic curve: 0.88; 95% confidence interval: 0.82–0.95, P < 0.0001). ConclusionComprehensive evaluation of LAAEV, SEC, and MR with associated LAAT may help risk stratifying the NVAF patients, especially if the LAA imaging quality was suboptimal for identifying thrombus. These parameters may facilitate the decision-making process at the time of TEE.