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

Jihoon Kim; Minjung Bak; Sung‐Ji Park; Dong Seop Jeong; Suryeun Chung; Darae Kim; Eun Kyoung Kim; Sung‐A Chang; Jin‐Oh Choi; Sang‐Chol Lee; Seung Woo Park

doi:10.1253/circj.cj-23-0040

June 26, 2023Circulation JournalOpen Access

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

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Why the study?

Data about predictors of AF recurrence after totally thoracoscopic ablation were limited, prompting investigation into the clinical implication of left atrial appendage emptying velocity.

Does preoperative left atrial appendage emptying velocity predict freedom from recurrent atrial fibrillation or atrial flutter in patients undergoing totally thoracoscopic ablation?

Structured PICO

Does preoperative left atrial appendage emptying velocity predict freedom from recurrent atrial fibrillation or atrial flutter in patients undergoing totally thoracoscopic ablation?

P

Population

n=129 adults with atrial fibrillation refractory to at least 1 antiarrhythmic drug or electrical cardioversion undergoing totally thoracoscopic ablation (TTA), mean age 54.4, 95.3% male, based in Republic of Korea. Exclusions: huge LA, severe pericardial adhesion, planned LAA resection alone, or no LAA resection during surgery.

I

Intervention

Preoperative measurement of left atrial appendage emptying velocity (LAAV) via transesophageal echocardiography, specifically patients with normal (≥40 cm/s) or intermediate (20 to <40 cm/s) LAAV.

C

Comparator

Patients with low left atrial appendage emptying velocity (LAAV <20 cm/s).

O

Outcome

Freedom from recurrent atrial fibrillation (AF) or atrial flutter (AFL) detected on 24-h Holter monitoring or an electrocardiogram over a 3-year period after TTA.

Limitations

Single-center study limiting generalizability
LAAV may be influenced by rhythm status during TEE
Potential multicollinearity between LAAV and other echocardiographic variables

Implication

Preoperative left atrial appendage emptying velocity (LAAV) is an independent predictor of long-term atrial fibrillation recurrence after totally thoracoscopic ablation, with LAAV <20 cm/s indicating high risk.

Abstract

BACKGROUND: 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. CONCLUSIONS: In patients with AF, LAAV was significantly associated with the risk of long-term recurrence of AF after TTA.