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Contrast defect of left atrial appendage on computed tomography is associated with higher risk of recurrence after catheter ablation in patients with paroxysmal atrial fibrillation

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Abstract

The previous study has shown that the contrast defect of the left atrial appendage (LAA) on contrast-enhanced cardiac computed tomography (CT) is associated with a higher rate of stroke in patients with atrial fibrillation (AF). This study aimed to investigate the association between LAA CT contrast defect and the risk of arrhythmia recurrence after catheter ablation (CA) in patients with paroxysmal AF. A total of 283 paroxysmal AF patients [age: 67 ± 10 years, 185 (65%) males] who underwent cardiac CT before CA were retrospectively analyzed. The presence or absence of LAA CT contrast defect was visually assessed using early phase CT images. Recurrence was an episode of atrial arrhythmia beyond the first 90 days post-ablation. LAA flow velocity was measured using transesophageal echocardiography in 246 paroxysmal AF patients. Sixty-eight (24%) patients had an LAA CT contrast defect. LAA flow velocity was significantly reduced in patients with LAA CT defect compared to those without (56.8 ± 28.7 cm/s vs. 41.1 ± 19.1 cm/s, p < 0.001). During a median follow-up period of 858 days, arrhythmia recurrence was identified in 85 (30%) patients. On a Kaplan Meier curve, patients with LAA CT contrast defect had significantly higher recurrence rates than those without (p = 0.043). On a multivariable Cox regression analysis, LAA CT contrast defect was a significant and independent predictor after adjustment of age, sex and left atrial volume index (hazard ratio: 1.79, 95% confidence interval: 1.03–3.07, p = 0.036). LAA CT contrast defect was associated with decreased LAA flow velocity and a higher rate of arrhythmia recurrence after CA, suggesting its usefulness as a non-invasive predictor for high-risk AF patients resistant to CA therapy.

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Abbreviations

AF:

Atrial fibrillation

CA:

Catheter ablation

CT:

Computed tomography

LAA:

Left atrial appendage

TEE:

Transesophageal echocardiography

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Taisuke Nakamura, Shingo Kato & Daisuke Utsunomiya

  2. Departments of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan

    Kazuki Fukui, Sho Kodama, Mai Azuma, Minako Kagimoto & Naoki Nakayama

  3. Departments of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan

    Tae Iwasawa

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  1. Taisuke Nakamura
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  2. Shingo Kato
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  3. Kazuki Fukui
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  4. Sho Kodama
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  5. Mai Azuma
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  9. Daisuke Utsunomiya
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Correspondence to Shingo Kato.

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Nakamura, T., Kato, S., Fukui, K. et al. Contrast defect of left atrial appendage on computed tomography is associated with higher risk of recurrence after catheter ablation in patients with paroxysmal atrial fibrillation. Heart Vessels 38, 394–401 (2023). https://doi.org/10.1007/s00380-022-02166-0

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