Patients with left atrial volume index <30 ml/m2 and left atrial appendage peak emptying velocity >46 cm/s had a significantly lower risk of AF recurrence (RR 0.18; 95% CI 0.06-0.55; p=0.002).
Cohort (n=90)
Do echocardiographic parameters (LAVI and LAAPEV) predict recurrence of atrial fibrillation in patients on rhythm control?
Smaller left atrial volume index and better left atrial appendage contractile function predict successful maintenance of sinus rhythm in patients with paroxysmal and persistent atrial fibrillation.
Effect estimate: RR 0.18 (95% CI 0.06-0.55)
p-value: p=0.002
BACKGROUND: Identification of good responders to rhythm control in the management of atrial fibrillation (AF) is worthwhile in terms of increasing hemodynamic benefit and decreasing the likelihood of unstable anticoagulation even after the Atrial Fibrillation Follow-Up Investigation of Rhythm Management. METHODS: We tested the hypothesis that atrial substrate determines the risk of recurrence on rhythm control both in patients with paroxysmal AF (PAF) and in those with persistent or sustained AF (> or =1 week, SAF). There were 90 consecutive patients (mean age 63 +/- 12 years, 67 males and 23 females) with previous PAF (n = 66) or SAF (n = 24). They were maintained in sinus rhythm successfully for at least 1 month after conversion and then studied by transthoracic and transesophageal echocardiography. All of the patients were followed regularly by determination of symptoms, 12-lead ECG and intermittent Holter recording to determine recurrence of AF after echocardiographic study. RESULTS: After 9.1 +/- 3.8 (range 3-12) months of follow-up, 23 of the 90 (26%) patients had documented recurrence of AF (67 without recurrence). Univariate analysis of demographic characteristics, medications, ECG and echocardiographic parameters revealed that, compared with the group of patients without recurrent AF, the group of those with it included more members of the SAF group (11/27 vs. 13/67, p = 0.039), included more male subjects (22/23 vs. 45/67, p = 0.045), had a larger left atrial volume index (LAVI; 27 +/- 9 vs. 22 +/- 9 ml/m2, p = 0.024) and had lower LA appendage peak emptying velocity (LAAPEV; 42 +/- 15 vs. 55 +/- 22 cm/s, p = 0.01). Multivariate Cox proportional hazards regression analysis adjusted for age, gender and AF group revealed that patients with LAVI 46 cm/s had the least recurrence of AF (relative risk 0.18, 95% confidence interval 0.06-0.55, vs. with LAVI >30 ml/m2 or LAAPEV 46 cm/s (p = 0.013) or both (p = 0.004). The superiority to predict the rate of sinus rhythm maintenance was the same in the PAF and SAF groups. CONCLUSIONS: Good responders to rhythm control in the PAF and SAF groups share the characteristics of smaller LA volume and better LAA contractile function, emphasizing the critical role of atrial substrate remodeling in recurrence of AF.
Wang et al. (Sat,) conducted a cohort in Paroxysmal and persistent atrial fibrillation (n=90). Left atrial volume index <30 ml/m2 and LA appendage peak emptying velocity >46 cm/s vs. LAVI >30 ml/m2 or LAAPEV <46 cm/s was evaluated on Recurrence of atrial fibrillation (RR 0.18, 95% CI 0.06-0.55, p=0.002). Patients with left atrial volume index <30 ml/m2 and left atrial appendage peak emptying velocity >46 cm/s had a significantly lower risk of AF recurrence (RR 0.18; 95% CI 0.06-0.55; p=0.002).
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