Compared with de novo organized left atrial tachyarrhythmia, paroxysmal AF was associated with lower odds of markedly reduced left atrial appendage peak emptying velocity (OR 0.19; 95% CI 0.06-0.62).
Cohort (n=634)
Yes
Does de novo organized left atrial tachyarrhythmia have preserved left atrial appendage mechanics compared to atrial fibrillation phenotypes in pre-ablation candidates?
De novo organized left atrial tachyarrhythmia exhibits significant LAA mechanical dysfunction comparable to long-standing persistent AF, indicating that an organized rhythm does not guarantee preserved appendage function.
Odds Ratio: 0.19 (95% CI 0.06–0.62)
Absolute Event Rate: 18.5% vs 2.7%
p-value: p=<0.001
ABSTRACT Purpose Whether de novo organized left atrial tachyarrhythmia (LAT) shows preserved left atrial appendage (LAA) mechanics has not been adequately characterized. We compared LAA peak emptying velocity across atrial fibrillation (AF) phenotypes and de novo LAT. Methods Multicenter retrospective cohort of 634 consecutive first‐ablation candidates undergoing pre‐ablation transesophageal echocardiography (TEE) at five centers: paroxysmal AF (PAF, n = 146), persistent AF (PeAF, n = 310), long‐standing persistent AF (LsPeAF, n = 86), and LAT ( n = 92). Markedly reduced LAA function was peak emptying velocity <25 cm/s. Multivariable regression adjusted for rhythm during TEE, CHA 2 DS 2 ‐VASc, body mass index (BMI), left ventricular ejection fraction (LVEF), and left atrial (LA) diameter. Results Mean LAA velocity was 55.7 ± 19.4 (PAF), 44.3 ± 18.5 (PeAF), 31.0 ± 12.5 (LsPeAF), and 36.6 ± 13.5 cm/s (LAT); p < 0.001. LAT lay closer to LsPeAF than to PAF and did not differ from LsPeAF (Tukey p = 0.140). Prevalence of velocity <25 cm/s: 2.7%, 11.9%, 32.6% and 18.5% ( p < 0.001). After adjustment, larger LA diameter ( β = −0.53/mm, p < 0.001) and higher CHA 2 DS 2 ‐VASc ( β = −1.93/point, p < 0.001) were independently associated with lower velocity. Compared with LAT, PAF had lower odds of velocity <25 cm/s (OR 0.19, 95% CI 0.06–0.62). Conclusion De novo organized LAT exhibits LAA mechanical dysfunction comparable to long‐standing persistent AF rather than to PAF. Organized rhythm does not imply preserved appendage function. LAA peak emptying velocity may serve as a functional remodeling marker for pre‐ablation phenotyping.
Wójcik et al. (Wed,) conducted a cohort in Atrial fibrillation and left atrial tachyarrhythmia (n=634). De novo organized left atrial tachyarrhythmia (LAT) vs. Paroxysmal AF (PAF) was evaluated on Markedly reduced LAA function (peak emptying velocity <25 cm/s) (OR 0.19, 95% CI 0.06-0.62, p=<0.001). Compared with de novo organized left atrial tachyarrhythmia, paroxysmal AF was associated with lower odds of markedly reduced left atrial appendage peak emptying velocity (OR 0.19; 95% CI 0.06-0.62).