Mechanics of atrial appendages and superior vena cava area assessed by transesophageal echocardiography in prediction of atrial fibrillation recurrence after pulmonary vein isolation

    Authors

    Keywords

    transesophageal echocardiography, atrial fibrillation, pulmonary vein isolation

    DOI

    https://doi.org/10.15836/ccar2018.347

    Full Text

    Introduction : Pulmonary vein isolation (PVI) by catheter ablation is well established for the treatment of paroxysmal atrial fibrillation (PAF). However, atrial fibrillation recurrence (AFR) is fairly common after the index PVI. Although there are numerous studies reflecting the AFR predictive factors, including different echocardiography parameters, data on appendages’ mechanics and superior vena cava’s area is rather scarce. ( 1 - 3 ) Hence, this study aimed to assess left (LAA) and right atrial appendage (RAA) mechanics by transesophageal echocardiography (TEE) and to explore its value in prediction of PAF after PVI. Patients and Methods : We conducted a single-centre, non-randomized, prospective cohort study. Consecutive patients undergoing AF ablation by means of pulmonary vein isolation were included in a prospective registry. Transthoracic echocardiogram (TTE) and 3D TEE were obtained prior to the ablation procedure, and analyzed offline in a standardized manner, including LAA strain, LAA strain rate, LAA tissue Doppler imaging (TDI) velocity, LAA surface area, SVC surface area, RAA TDI velocity. The primary end point was freedom from any documented recurrence of atrial arrhythmia lasting > 30 seconds. A total of 55 patients with PAF in whom TTE and 3D TEE prior to index PVI was done were included (median age 59 years; IQR 52-63; female 30%; BMI 27.9±4.3 kg/m 2 , LVEF 60%, LA volume index 34 mL/m 2 ). After a median follow up of 12 (IQR 10-12) months, 15 patients had AFR (R-group) and 40 patients had no recurrence (NR-group). Compared to NR-group, patients in R-group had lower LAA TDI (9.53±1.54 vs. 10.56±1.68 cm/s, p=0.014) and LAA surface area (2.55±0.62 vs. 2.84±0.66 cm 2 , p=0.045). RAA TDI velocity (p=0.292) and SVC surface area (p=0.361) were not different between the study groups. Conclusion : TEE parameters of RAA and SVC did not differ between patients with and without AFR. However, LAA TDI emptying velocity and LAA surface area could be useful in follow-up of PAF patients after index PVI in clinical settings. To our knowledge, this is the first study assessing RAA’ mechanics and SVC surface area in predicting AFR after PVI.

    Cardiologia Croatica
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    Mechanics of atrial appendages and superior vena cava area assessed by transesophageal echocardiography in prediction of atrial fibrillation recurrence after pulmonary vein isolation

    Extended Abstract
    Issue11-12
    Published
    Pages347
    PDF via DOIhttps://doi.org/10.15836/ccar2018.347
    transesophageal echocardiography
    atrial fibrillation
    pulmonary vein isolation

    Authors

    Ivan Zeljković*ORCIDUniversity Hospital Centre “Sestre milosrdnice”, Zagreb, Croatia
    Nikola PavlovićORCIDUniversity Hospital Centre “Sestre milosrdnice”, Zagreb, Croatia
    Krešimir KordićORCIDUniversity Hospital Centre “Sestre milosrdnice”, Zagreb, Croatia
    Nikola KosORCIDUniversity Hospital Centre “Sestre milosrdnice”, Zagreb, Croatia
    Ivica BenkoORCIDUniversity Hospital Centre “Sestre milosrdnice”, Zagreb, Croatia
    Karlo GolubićORCIDUniversity Hospital Centre “Sestre milosrdnice”, Zagreb, Croatia
    Kristijan ĐulaORCIDUniversity Hospital Centre “Sestre milosrdnice”, Zagreb, Croatia
    Diana Delić-BrkljačićORCIDUniversity Hospital Centre “Sestre milosrdnice”, Zagreb, Croatia
    Vjekoslav RadeljićORCIDUniversity Hospital Centre “Sestre milosrdnice”, Zagreb, Croatia
    Šime ManolaORCIDUniversity Hospital Centre “Sestre milosrdnice”, Zagreb, Croatia
    Nikola BuljORCIDUniversity Hospital Centre “Sestre milosrdnice”, Zagreb, Croatia

    Full Text

    Introduction : Pulmonary vein isolation (PVI) by catheter ablation is well established for the treatment of paroxysmal atrial fibrillation (PAF). However, atrial fibrillation recurrence (AFR) is fairly common after the index PVI. Although there are numerous studies reflecting the AFR predictive factors, including different echocardiography parameters, data on appendages’ mechanics and superior vena cava’s area is rather scarce. ( 1 - 3 ) Hence, this study aimed to assess left (LAA) and right atrial appendage (RAA) mechanics by transesophageal echocardiography (TEE) and to explore its value in prediction of PAF after PVI. Patients and Methods : We conducted a single-centre, non-randomized, prospective cohort study. Consecutive patients undergoing AF ablation by means of pulmonary vein isolation were included in a prospective registry. Transthoracic echocardiogram (TTE) and 3D TEE were obtained prior to the ablation procedure, and analyzed offline in a standardized manner, including LAA strain, LAA strain rate, LAA tissue Doppler imaging (TDI) velocity, LAA surface area, SVC surface area, RAA TDI velocity. The primary end point was freedom from any documented recurrence of atrial arrhythmia lasting > 30 seconds. A total of 55 patients with PAF in whom TTE and 3D TEE prior to index PVI was done were included (median age 59 years; IQR 52-63; female 30%; BMI 27.9±4.3 kg/m 2 , LVEF 60%, LA volume index 34 mL/m 2 ). After a median follow up of 12 (IQR 10-12) months, 15 patients had AFR (R-group) and 40 patients had no recurrence (NR-group). Compared to NR-group, patients in R-group had lower LAA TDI (9.53±1.54 vs. 10.56±1.68 cm/s, p=0.014) and LAA surface area (2.55±0.62 vs. 2.84±0.66 cm 2 , p=0.045). RAA TDI velocity (p=0.292) and SVC surface area (p=0.361) were not different between the study groups. Conclusion : TEE parameters of RAA and SVC did not differ between patients with and without AFR. However, LAA TDI emptying velocity and LAA surface area could be useful in follow-up of PAF patients after index PVI in clinical settings. To our knowledge, this is the first study assessing RAA’ mechanics and SVC surface area in predicting AFR after PVI.