Left atrial appendage emptying velocity independently predicted early recurrence of atrial tachyarrhythmia after ablation (aOR 0.921 per cm/s), and an integrative AF-RI score achieved an AUC of 0.917.
Cohort (n=157)
No
Does the AF-RI score (integrating LAD, LAAEV, and NT-proBNP) predict early recurrence of atrial tachyarrhythmia in patients with drug-refractory non-valvular AF undergoing first-time RFCA?
The novel AF-RI score, integrating left atrial diameter, left atrial appendage emptying velocity, and NT-proBNP, provides a highly discriminative tool for predicting early recurrence of atrial tachyarrhythmia after first-time ablation.
Estimación del efecto: aOR 0.921 (95% CI 0.877-0.968)
valor p: p=0.001
Background Early recurrence of atrial tachyarrhythmia (ERAF) after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) remains a major clinical challenge. While left atrial diameter (LAD) is a known predictor, the role of atrial mechanical function, particularly left atrial appendage emptying velocity (LAAEV), and its integration with other markers needs clarification. Methods This single-center retrospective cohort study included 157 drug-refractory non-valvular AF patients undergoing first-time RFCA. Among them, 53 (33.8%) developed ERAF within the 90-day blanking period. Baseline clinical, echocardiographic (including LAD and LAAEV), and biochemical (NT-proBNP) data were collected. The primary endpoint was ERAF (atrial tachycardia/flutter/fibrillation ≥30 s) within the 90-day blanking period. Predictive models were developed using logistic regression. An integrative AF Recurrence Index (AF-RI) was derived and validated internally. Results Among 157 patients, 53 (33.8%) experienced ERAF. The ERAF group exhibited a distinct “atrial failure” phenotype: larger LAD (43.8 ± 5.6 vs. 39.5 ± 4.3 mm, p 0.001), lower LAAEV (35.8 ± 9.9 vs. 47.6 ± 11.9 cm/s, p 0.001), and higher NT-proBNP (median 356.9 vs. 207.2 pg/mL, p = 0.023). LAAEV was a stronger independent predictor (AUC: 0.812, 95% CI: 0.742–0.882) than LAD (AUC: 0.745, 95% CI: 0.665–0.825). The AF-RI, integrating LAD, LAAEV, and NT-proBNP, demonstrated outstanding discrimination (AUC: 0.917, 95% CI: 0.874–0.960), with significantly higher sensitivity (88.7%) and specificity (84.6%) than single-parameter models (all p 0.05). Correlation network analysis positioned LAAEV as a central hub linking structural and neurohormonal remodeling. Patients stratified by LAAEV tertiles showed dramatically graded ERAF risks (14.8%, 28.3%, 58.5%, p -trend 0.001). Conclusion LAAEV is a potent, independent predictor of ERAF, central to an “atrial failure” phenotype. The integrative AF-RI score provides a simple, bedside-friendly tool for individualized risk stratification, enabling clinicians to identify high-risk patients (e.g., those with LAAEV 35 cm/s) who may benefit from intensified monitoring or tailored therapeutic strategies post-ablation.
Wang et al. (Wed,) conducted a cohort in Drug-refractory non-valvular atrial fibrillation (n=157). Left atrial appendage emptying velocity (LAAEV) was evaluated on Early recurrence of atrial tachyarrhythmia (ERAF) within the 90-day blanking period (aOR 0.921, 95% CI 0.877-0.968, p=0.001). Left atrial appendage emptying velocity independently predicted early recurrence of atrial tachyarrhythmia after ablation (aOR 0.921 per cm/s), and an integrative AF-RI score achieved an AUC of 0.917.