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Predictors for reduced flow velocity in left atrial appendage during sinus rhythm in patients with atrial fibrillation

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Abstract

Discontinuation of anticoagulation therapy after catheter ablation (CA) for atrial fibrillation (AF) remains controversial. While decreased left atrial appendage flow velocity (LAAFV) during AF leads to left atrial appendage thrombus and embolic events, some AF patients show decreased LAAFV even during sinus rhythm (SR). We studied 392 patients (256 males, 68 ± 10 years) who exhibited SR during transesophageal echocardiography (TEE) before CA for AF. Clinical factors, transthoracic echocardiography, and blood samples were obtained before TEE. Reduced LAAFV was defined as < 35 cm/s of LAAFV. Reduced LAAFV was observed in 72/392 patients (18%). Reduced LAAFV was significantly associated with high prevalence of non-paroxysmal AF, elevated brain natriuretic peptide (BNP), prior heart failure, high CHADS2 score, high CHA2DS2-VASc score, no beta blocker administration, increased left atrial volume index (LAVI), elevated E/eʹ ratio, reduced left ventricular ejection fraction and high prevalence of left ventricular hypertrophy. On multivariate analysis, BNP (P = 0.0005, OR 1.045 for each 10 pg/ml increase in BNP, 95% CI 1.018–1.073) and LAVI (P = 0.0045, OR 1.044 for each 1 increase in LAVI, 95% CI 1.013–1.077) were associated with decreased LAAFV. The elevated BNP levels and large LAVI predict decreased LAAFV during SR in patients with AF.

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Abbreviations

AF:

Atrial fibrillation

CA:

Catheter ablation

PVI:

Pulmonary vein isolation

LAA:

Left atrial appendage

SR:

Sinus rhythm

LAAFV:

Left atrial appendage flow velocity

TEE:

Transesophageal echocardiography

Reduced LAAFV:

The reduced LAAFV group

Normal LAAFV:

The normal LAAFV group

TTE:

Transthoracic echocardiography

LA:

Left atrial

LAVI:

Left atrial volume index

LV:

Left ventricular

LVDd:

Left ventricular dimension during end diastole

LVEF:

Left ventricular ejection fraction

VH:

Left ventricular hypertrophy

SEC:

Spontaneous echocardiography contrast

OR:

Odds ratio

ROC:

Receiver operating characteristic

BNP:

Brain natriuretic peptide

CHF:

Chronic heart failure

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya, Japan

    Eiji Fukuhara, Takanao Mine, Hideyuki Kishima & Masaharu Ishihara

  2. Department of Advanced Cardiac Therapeutics, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan

    Takanao Mine

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  1. Eiji Fukuhara
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Fukuhara, E., Mine, T., Kishima, H. et al. Predictors for reduced flow velocity in left atrial appendage during sinus rhythm in patients with atrial fibrillation. Heart Vessels 36, 393–400 (2021). https://doi.org/10.1007/s00380-020-01702-0

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