Predictors for reduced flow velocity in left atrial appendage during sinus rhythm in patients with atrial fibrillation
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ORIGINAL ARTICLE
Predictors for reduced flow velocity in left atrial appendage during sinus rhythm in patients with atrial fibrillation Eiji Fukuhara1 · Takanao Mine1,2 · Hideyuki Kishima1 · Masaharu Ishihara1 Received: 10 May 2020 / Accepted: 11 September 2020 © Springer Japan KK, part of Springer Nature 2020
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 95 (female) or 115 (male), the patient was considered to have LVH [17]. All patients underwent TEE within 72 h before the CA procedure using a 5 MHz multiplane transesophageal transducer connected to an ultrasound system (iE33 or EPIQ7; Philips Medical Systems, Andover, Massachusetts). After local pharyngeal anesthesia with lidocaine spray, the patients were placed in the left lateral position, and the transesophageal transducer was inserted in the esophagus. We assessed the LAAFV, the LAA orifice area, LA thrombus, spontaneous echocardiography contrast (SEC), and heart rate during TEE. The LAAFV was obtained at the outlet of the LAA by the pulsed Doppler method. The sample volume was placed within the LAA cavity > 1 cm away from the LA cavity. The peak emptying velocities were analyzed and averaged for 5 cardiac cycles. A LA thrombus was defined as being present if there was a mass that could be distinguished from the surrounding endocardium or pectinate muscles. SEC was defined as a pattern of dynamic “smoke-like”, slowly swirling, intracavitary echo-densities imaged with gain settings adjusted to eliminate background noise [15]. No complications from any of the TEE procedures were reported.
Statistical analysis Continuous variables are expressed as mean ± 1 standard deviation and were compared using one-way analysis of variance (ANOVA). Differences between categorical variables were evaluated with χ2 test or Fisher’s test. The strength of bivariate associations between reduced LAAFV and its potential predictors were measured using odds ratio (OR). Parameters that were associated with a P value of
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