Left atrial appendage flow velocity and time from P-wave onset to tissue Doppler-derived A' predict atrial fibrillation recurrence after radiofrequency catheter ablation

Echocardiography. 2015 Jul;32(7):1101-8. doi: 10.1111/echo.12823. Epub 2014 Nov 1.


Background: Atrial fibrillation (AF) is associated with atrial remodeling. We investigate the abilities of preprocedural echocardiographic parameters reflecting atrial remodeling to predict AF recurrence after radiofrequency catheter ablation (RFCA) for paroxysmal AF (PAF).

Methods: Preprocedural echocardiographic parameters were measured during sinus rhythm in 105 patients with PAF undergoing RFCA. Electrical remodeling was assessed by the time from the onset of the P-wave to the peak A'-wave on the tissue Doppler imaging (PA-TDI), functional remodeling was assessed by the left atrial appendage flow velocity (LAAFV), and structural remodeling was assessed by the left atrial volume index (LAVI). PA-TDI, LAAFV, and LAVI values were divided into tertiles, and their abilities to predict AF recurrence were assessed using Cox regression analysis.

Results: AF recurrence occurred in 39/105 (37.1%) patients. After adjustment for confounders, the rate of AF recurrence was significantly higher in the highest tertile of PA-TDI compared with the lowest tertile (≥151.3 msec vs. <131.0 msec; hazard ratio [HR]: 2.477, 95% confidence interval [CI]: 1.031-5.950; P = 0.042), and in the lowest tertile of LAAFV compared with the highest tertile (<48.5 cm/sec vs. ≥64.9 cm/sec; HR: 2.680, 95% CI: 1.136-6.318; P = 0.024). The risk of AF recurrence was also higher in the highest tertile of LAVI (≥34.2 mL/m(2) ) compared with the lowest tertile, but this difference was not significant (HR: 2.146, 95% CI: 0.834-5.523; P = 0.113).

Conclusions: LAAFV (reflecting functional remodeling) and PA-TDI (reflecting electrical remodeling) are independent predictors of AF recurrence after RFCA for PAF.

Keywords: atrial remodeling; left atrial appendage flow velocity; left atrial volume index; paroxysmal atrial fibrillation; radiofrequency catheter ablation; total atrial conduction time.

MeSH terms

  • Atrial Appendage / diagnostic imaging
  • Atrial Appendage / physiopathology*
  • Atrial Fibrillation / diagnostic imaging
  • Atrial Fibrillation / physiopathology
  • Atrial Fibrillation / surgery*
  • Atrial Remodeling
  • Catheter Ablation*
  • Echocardiography, Doppler*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / diagnosis*
  • Postoperative Complications / physiopathology
  • Predictive Value of Tests
  • Preoperative Care*
  • Prospective Studies
  • Recurrence
  • Risk Assessment
  • Time Factors