Key result
Preoperative LAAEV < 25 cm/s linked to ~6% greater LAVmax reduction versus higher velocities after LAAC and ablation.
Why the study?
The effect of different preoperative left atrial appendage emptying speeds on left atrial function after combined left atrial appendage closure and catheter ablation in persistent atrial fibrillation patients was unclear.
Does preoperative LAAEV < 25 cm/s compared to ≥ 25 cm/s affect left atrial function improvement in patients with persistent AF after combined LAAC and catheter ablation?
Cohort (n=82)
No
Does preoperative LAAEV < 25 cm/s compared to ≥ 25 cm/s affect left atrial function improvement in patients with persistent AF after combined LAAC and catheter ablation?
Absolute Event Rate: -0.2% vs -0.14%
p-value: p=0.036
Patients with persistent AF and lower preoperative LAAEV (<25 cm/s) have worse baseline LA function but experience significant improvement after combined LAAC and catheter ablation, reaching similar LA function at 12 months as those with higher LAAEV.
Supports LAAEV as a potential marker of LA remodeling response in persistent AF; extends prior observational data but requires prospective validation before clinical use.
Objective The present study aimed to investigate whether different preoperative left atrial appendage emptying speeds (LAAEVs) have an effect on left atrial function in patients with sinus arrhythmia after left atrial appendage closure (LAAC) combined with catheter ablation (CA). Methods A total of 163 patients with persistent non-valvular atrial fibrillation who received combined LAAC+CA surgery were included in the present study. Regular follow-up was conducted for 12 months, and patients with complete data and successful sinus rhythm recovery were selected as the study subjects (n = 82). The patients were divided into two groups: the LAAEV < 25 cm/s group and the LAAEV ≥ 25 cm/s group (n = 41 each). The propensity score was used for matching according to gender, age, CHA2DS2-VASc score, and HAS-BLED score. The changes in the two groups in LA structure, storage function, conduit function, and pump function were compared. Results Before surgery, the maximum LA volume (LAVmax) and minimum LA volume (LAVmin) were greater in the LAAEV < 25 cm/s group than in the LAAEV ≥ 25 cm/s group. The LA storage function (eg. Ƹ and SRs), conduit function (eg. SRe), and pump function (eg. SRa) were all worse in the LAAEV < 25 cm/s group than in the LAAEV ≥ 25 cm/s group. After the combined LAAC+CA surgery, the LA storage, conduit, and pump functions improved in both groups. At 12 months after surgery, there were no statistically significant differences between the two groups. Conclusion Before combined LAAC+CA surgery, the LA structure and function of the LAAEV < 25 cm/s group were worse than those of the LAAEV ≥ 25 cm/s group. However, after LAAC+CA surgery, the LA structure and function of the patients were improved, and there were no significant differences between the two groups. Inferred improvement in LA structure and function in the LAAEV < 25 cm/s group was superior to that in the LAAEV ≥ 25 cm/s group.
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Yang et al. (2022) conducted a cohort in Persistent non-valvular atrial fibrillation (n=82). Preoperative left atrial appendage emptying speed (LAAEV) < 25 cm/s vs. LAAEV ≥ 25 cm/s was evaluated on 12-month rate of change in maximum left atrial volume (ΔLAVmax) (p=0.036). Preoperative LAAEV < 25 cm/s was associated with a significantly greater 12-month reduction in maximum left atrial volume (-20% vs -14%, p=0.036) compared to LAAEV ≥ 25 cm/s after LAAC and ablation.
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