Clinical value of left atrial appendage flow for prediction of long-term sinus rhythm maintenance in patients with nonvalvular atrial fibrillation

Emanuele Antonielli, Alfredo Pizzuti, A. Pálinkás, Mattia Tanga, N. oèmi Gruber, Claudio Michelassi, A. Varga, Alessandro Bonzano, Nicola Gandolfo, L. ászlo Halmai, Antonia Bassignana, Muhammad Babar Imran, Fabrizio Delnevo, M. Csanády, Eugenio Picano

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Abstract

OBJECTIVES: This study evaluated the role of various clinical and echocardiographic parameters, including the left atrial appendage (LAA) anterograde flow velocity, for prediction of the long-term preservation of sinus rhythm (SR) in patients with successful cardioversion (CV) of nonvalvular atrial fibrillation (AF). BACKGROUND: Echocardiographic parameters for assessing long-term SR maintenance after successful CV of nonvalvular AF are not accurately defined. METHODS: Clinical, transthoracic echocardiographic and transesophageal echocardiographic (TEE) data - measured in AF lasting >48 h - of 186 consecutive patients (116 men, mean age: 65 ± 9 years) with successful CV (electrical or pharmacologic) were analyzed for assessment of one-year maintenance of SR. RESULTS: At one-year follow-up, 91 of 186 (49%) patients who underwent successful CV continued to have SR. Mean LAA peak emptying flow velocity was higher in patients remaining in SR for one year than in those with AF relapse (41.7 ± 20.2 cm/s vs. 27.7 ± 17.0 cm/s; p <0.001). On multivariate logistic regression analysis, only the mean LAA peak emptying velocity >40 cm/s (p = 0.0001; X2: 23.9, odds ratio [OR] = 5.2, confidence interval [CI] 95% = 2.7 to 10.1) and the use of preventive antiarrhythmic drug treatment (p = 0.0398; X2: 4.2; OR = 2.0, CI 95% = 1.0 to 3.8) predicted the continuous preservation of SR during one year, outperforming other univariate predictors such as absence of left atrial spontaneous echocardiographic contrast during TEE, the left atrial parasternal diameter 46% and AF duration 40 cm/s for assessing preservation of SR were 66% (CI 95% = 56.9 to 74.2) and 73% (CI 95% = 62.4 to 83.3), respectively. CONCLUSIONS: In TEE-guided management of nonvalvular AF, high LAA flow velocity identifies patients with greater likelihood to remain in SR for one year after successful CV. Low LAA velocity is of limited value in identifying patients who will relapse into AF.

Original languageEnglish
Pages (from-to)1443-1449
Number of pages7
JournalJournal of the American College of Cardiology
Volume39
Issue number9
DOIs
Publication statusPublished - May 1 2002

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Atrial Appendage
Atrial Fibrillation
Electric Countershock
Maintenance
Confidence Intervals
Odds Ratio
Recurrence
Anti-Arrhythmia Agents

ASJC Scopus subject areas

  • Nursing(all)

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Clinical value of left atrial appendage flow for prediction of long-term sinus rhythm maintenance in patients with nonvalvular atrial fibrillation. / Antonielli, Emanuele; Pizzuti, Alfredo; Pálinkás, A.; Tanga, Mattia; Gruber, N. oèmi; Michelassi, Claudio; Varga, A.; Bonzano, Alessandro; Gandolfo, Nicola; Halmai, L. ászlo; Bassignana, Antonia; Imran, Muhammad Babar; Delnevo, Fabrizio; Csanády, M.; Picano, Eugenio.

In: Journal of the American College of Cardiology, Vol. 39, No. 9, 01.05.2002, p. 1443-1449.

Research output: Contribution to journalArticle

Antonielli, E, Pizzuti, A, Pálinkás, A, Tanga, M, Gruber, NO, Michelassi, C, Varga, A, Bonzano, A, Gandolfo, N, Halmai, LÁ, Bassignana, A, Imran, MB, Delnevo, F, Csanády, M & Picano, E 2002, 'Clinical value of left atrial appendage flow for prediction of long-term sinus rhythm maintenance in patients with nonvalvular atrial fibrillation', Journal of the American College of Cardiology, vol. 39, no. 9, pp. 1443-1449. https://doi.org/10.1016/S0735-1097(02)01800-4
Antonielli, Emanuele ; Pizzuti, Alfredo ; Pálinkás, A. ; Tanga, Mattia ; Gruber, N. oèmi ; Michelassi, Claudio ; Varga, A. ; Bonzano, Alessandro ; Gandolfo, Nicola ; Halmai, L. ászlo ; Bassignana, Antonia ; Imran, Muhammad Babar ; Delnevo, Fabrizio ; Csanády, M. ; Picano, Eugenio. / Clinical value of left atrial appendage flow for prediction of long-term sinus rhythm maintenance in patients with nonvalvular atrial fibrillation. In: Journal of the American College of Cardiology. 2002 ; Vol. 39, No. 9. pp. 1443-1449.
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T1 - Clinical value of left atrial appendage flow for prediction of long-term sinus rhythm maintenance in patients with nonvalvular atrial fibrillation

AU - Antonielli, Emanuele

AU - Pizzuti, Alfredo

AU - Pálinkás, A.

AU - Tanga, Mattia

AU - Gruber, N. oèmi

AU - Michelassi, Claudio

AU - Varga, A.

AU - Bonzano, Alessandro

AU - Gandolfo, Nicola

AU - Halmai, L. ászlo

AU - Bassignana, Antonia

AU - Imran, Muhammad Babar

AU - Delnevo, Fabrizio

AU - Csanády, M.

AU - Picano, Eugenio

PY - 2002/5/1

Y1 - 2002/5/1

N2 - OBJECTIVES: This study evaluated the role of various clinical and echocardiographic parameters, including the left atrial appendage (LAA) anterograde flow velocity, for prediction of the long-term preservation of sinus rhythm (SR) in patients with successful cardioversion (CV) of nonvalvular atrial fibrillation (AF). BACKGROUND: Echocardiographic parameters for assessing long-term SR maintenance after successful CV of nonvalvular AF are not accurately defined. METHODS: Clinical, transthoracic echocardiographic and transesophageal echocardiographic (TEE) data - measured in AF lasting >48 h - of 186 consecutive patients (116 men, mean age: 65 ± 9 years) with successful CV (electrical or pharmacologic) were analyzed for assessment of one-year maintenance of SR. RESULTS: At one-year follow-up, 91 of 186 (49%) patients who underwent successful CV continued to have SR. Mean LAA peak emptying flow velocity was higher in patients remaining in SR for one year than in those with AF relapse (41.7 ± 20.2 cm/s vs. 27.7 ± 17.0 cm/s; p <0.001). On multivariate logistic regression analysis, only the mean LAA peak emptying velocity >40 cm/s (p = 0.0001; X2: 23.9, odds ratio [OR] = 5.2, confidence interval [CI] 95% = 2.7 to 10.1) and the use of preventive antiarrhythmic drug treatment (p = 0.0398; X2: 4.2; OR = 2.0, CI 95% = 1.0 to 3.8) predicted the continuous preservation of SR during one year, outperforming other univariate predictors such as absence of left atrial spontaneous echocardiographic contrast during TEE, the left atrial parasternal diameter 46% and AF duration 40 cm/s for assessing preservation of SR were 66% (CI 95% = 56.9 to 74.2) and 73% (CI 95% = 62.4 to 83.3), respectively. CONCLUSIONS: In TEE-guided management of nonvalvular AF, high LAA flow velocity identifies patients with greater likelihood to remain in SR for one year after successful CV. Low LAA velocity is of limited value in identifying patients who will relapse into AF.

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