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Clinical impact of quantitative left atrial vortex flow analysis in patients with atrial fibrillation: a comparison with invasive left atrial voltage mapping

  • Jung Myung Lee
  • Geu-Ru HongEmail author
  • Hui-Nam Pak
  • Chi Young Shim
  • Helene Houle
  • Mani A. Vannan
  • Minji Kim
  • Namsik Chung
Original Paper

Abstract

Recently, left atrial (LA) vortex flow analysis using contrast transesophageal echocardiography (TEE) has been shown to be feasible and has demonstrated significant differences in vortex flow morphology and pulsatility between normal subjects and patients with atrial fibrillation (AF). However, the relationship between LA vortex flow and electrophysiological properties and the clinical significance of LA vortex flow are unknown. The aims of this study were (1) to compare LA vortex flow parameters with LA voltage and (2) to assess the predictive value of LA vortex flow parameters for the recurrence of AF after radiofrequency catheter ablation (RFCA). Thirty-nine patients with symptomatic non-valvular AF underwent contrast TEE before undergoing RFCA for AF. Quantitative LA vortex flow parameters were analyzed by Omega flow (Siemens Medical Solution, Mountain View, CA, USA). The morphology and pulsatility of LA vortex flow were compared with electrophysiologic parameters that were measured invasively. Hemodynamic, electrophysiological, and vortex flow parameters were compared between patients with and without early recurrence of AF after RFCA. Morphologic parameters, including LA vortex depth, length, width, and sphericity index were not associated with LA voltage or hemodynamic parameters. The relative strength (RS), which represents the pulsatility power of LA, was positively correlated with LA voltage (R = 0.53, p = 0.01) and LA appendage flow velocity (R = 0.73, p < 0.001) and negatively correlated with LA volume index (R = −0.56, p < 0.001). Patients with recurrent AF after RFCA showed significantly lower RS (1.7 ± 0.2 vs 1.9 ± 0.4, p = 0.048) and LA voltage (0.9 ± 0.7 vs 1.7 ± 0.8, p = 0.004) than patients without AF recurrence. In the relatively small LA dimension group (LA volume index ≤ 33 ml/m2), RS was significantly lower (2.1 ± 0.3 vs 1.7 ± 0.1, p = 0.029) in patients with the recurrent AF. Quantitative LA vortex flow analysis, especially RS, correlated well with LA voltage. Decreased pulsatility strength in the LA was associated with recurrent AF. LA vortex may have incremental value in predicting the recurrence of AF.

Keywords

Vortex Left atrium Atrial fibrillation Transesophageal echocardiography 

Notes

Acknowledgments

We appreciate Mr. Jun-Kee Lee for his technical assistance. Geu-Ru Hong—Research supported by Siemens Medical Solution.

Conflict of interest

None.

Supplementary material

10554_2015_671_MOESM1_ESM.asf (18.3 mb)
Supplementary material 1 (ASF 18766 kb)

Supplementary material 2 (WMV 13090 kb)

Supplementary material 3 (WMV 13051 kb)

10554_2015_671_MOESM4_ESM.doc (35 kb)
Supplementary material 4 (DOC 35 kb)

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Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Jung Myung Lee
    • 1
  • Geu-Ru Hong
    • 1
    Email author
  • Hui-Nam Pak
    • 1
  • Chi Young Shim
    • 1
  • Helene Houle
    • 2
  • Mani A. Vannan
    • 3
  • Minji Kim
    • 4
  • Namsik Chung
    • 1
  1. 1.Division of Cardiology, Yonsei Cardiovascular CenterYonsei University College of MedicineSeoulRepublic of Korea
  2. 2.Siemens Medical SolutionsMountain ViewUSA
  3. 3.Department of Cardiovascular ImagingPiedmont Heart InstituteAtlantaUSA
  4. 4.School of MedicineUniversity of QueenslandHerstonAustralia

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