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

Q: What does this research mean for the field?

Low pre-ablation left atrial appendage filling velocity (LAAfV <48 cm/s) is an independent predictor of 3-year atrial fibrillation recurrence following a single radiofrequency ablation in patients with paroxysmal atrial fibrillation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Jing Cui; Xin Du; Liu He; Shijun Xia; Ribo Tang; Caihua Sang; Deyong Long; Jianzeng Dong; Changsheng Ma

doi:10.1111/pace.14828

September 22, 2023Pacing and Clinical ElectrophysiologyOpen Access

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

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Why the study?

Many patients with paroxysmal atrial fibrillation experience recurrence after a single ablation, prompting investigation into whether pre-ablation left atrial appendage emptying and filling velocities relate to 3-year recurrence.

Does low pre-ablation left atrial appendage flow velocity predict AF recurrence in patients with paroxysmal atrial fibrillation undergoing their first catheter ablation?

Structured PICO

Does low pre-ablation left atrial appendage flow velocity predict AF recurrence in patients with paroxysmal atrial fibrillation undergoing their first catheter ablation?

P

Population

658 consecutive patients with paroxysmal atrial fibrillation (PAF) who underwent their first catheter ablation

I

Intervention

Low left atrial appendage filling velocity (LAAfV <48 cm/s) or emptying velocity (LAAeV <55 cm/s) measured by pre-ablation transesophageal echocardiogram (TEE)

C

Comparator

High left atrial appendage filling velocity (LAAfV ≥48 cm/s) or emptying velocity (LAAeV ≥55 cm/s)

O

Outcome

AF recurrencehard clinical

Low left atrial appendage filling velocity on pre-ablation TEE is an independent predictor of 3-year AF recurrence after first-time radiofrequency ablation for paroxysmal AF.

Implication

Low pre-ablation LAAfV may aid recurrence risk stratification after paroxysmal AF ablation; leaves open prospective validation before guiding practice.

Abstract

BACKGROUND: 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. METHODS: 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. RESULTS: 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 ± 21.2 vs. 59.6 ± 20.7 cm/s, p = .052; LAAfV: 47.5 ± 17.9 vs. 51.7 ± 18.2, p = .003). Kaplan-Meier analysis showed that patients in the low LAAeV (<55 cm/s) group had a poorer event-free survival rate than those in the high LAAeV (≥55 cm/s) group (log-rank p = .012). Patients with LAAfV <48 cm/s had a significantly higher risk of AF recurrence than those with LAAfV ≥48 cm/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. CONCLUSION: 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.