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

Wei Li; Qunying Zhang; Le Cao; Jinshu Wang; Ling Guo; Qiang Zhang; Qiang Zhang

doi:10.1111/echo.15958

October 1, 2024EchocardiographyOpen Access

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

View Full Paper

Ask AI

Bookmark

Share

Why the study?

To evaluate whether assessing left atrium and left atrial appendage attributes using TEE and speckle tracking imaging can predict recurring AF following radiofrequency catheter ablation.

Do left atrial appendage emptying velocity and strain assessed by TEE predict recurring atrial fibrillation after radiofrequency catheter ablation in patients with AF?

Key Points

To evaluate whether preoperative assessment of left atrial and left atrial appendage structure and function using transesophageal echocardiography and speckle tracking imaging can predict atrial fibrillation recurrence following radiofrequency catheter ablation.
Enrolled 80 patients with atrial fibrillation undergoing preoperative transthoracic echocardiography and transesophageal echocardiography prior to radiofrequency catheter ablation.
Tracked postoperative recurrence of atrial fibrillation at 3, 6, and 12 months.
Identified independent predictors using multifactorial logistic regression and determined optimal cutoff thresholds, sensitivity, and specificity via receiver operating characteristic curve analysis.
Recurrence occurred in 17 of 80 patients (21.25%), who showed significantly increased left atrial and left atrial appendage dimensions along with reduced left atrial appendage emptying velocity (LAAeV) and strain (LAAS).
Multifactorial regression confirmed LAAeV and LAAS as independent predictors of recurrence, with cutoff values of 34.5 cm/s (AUC: 0.954, sensitivity: 94.1%, specificity: 92.1%) and 11.61% (AUC: 0.925, sensitivity: 82.4%, specificity: 95.2%), respectively.
Combining LAAeV and LAAS yielded an overall AUC of 0.978, with a sensitivity of 94.1% and a specificity of 93.7% for predicting recurrence.

Structured PICO

Do left atrial appendage emptying velocity and strain assessed by TEE predict recurring atrial fibrillation after radiofrequency catheter ablation in patients with AF?

P

Population

80 patients with atrial fibrillation (AF) undergoing radiofrequency catheter ablation who had preoperative transthoracic echocardiography and transesophageal echocardiography (TEE).

I

Intervention

Assessment of left atrial appendage (LAA) functions, specifically LAA emptying velocity (LAAeV) and LAA strain (LAAS), using transesophageal echocardiography (TEE) and speckle tracking imaging.

O

Outcome

Recurring atrial fibrillation postoperatively at 3, 6, and 12 months.hard clinical

Left atrial appendage emptying velocity and strain measured by TEE and speckle tracking imaging are strong independent predictors of AF recurrence after radiofrequency catheter ablation.

Implication

May aid pre-ablation risk stratification; leaves open prospective validation before clinical adoption.

Abstract

OBJECTIVE: 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. METHODS: 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. RESULTS: 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 34.5 cm/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. CONCLUSION: The LAAeV and LAAS independently influenced the postoperative recurrence of AF.