title: Clinical value of left atrial appendage flow for prediction of long-term sinus rhythm maintenance in patients with nonvalvular atrial fibrillation.
abstract: OBJECTIVE
  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; chi(2): 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; chi(2): 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 <44 mm, left ventricular ejection fraction >46% and AF duration <1 week before CV. The negative and positive predictive values of the mean LAA peak emptying velocity >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.
authors: Divisione di Cardiologia, Ospedale SS. Annunziata, Savigliano, Italy.
authors: Emanuele
authors: E
authors: Antonielli
authors: Alfredo
authors: A
authors: Pizzuti
authors: Attila
authors: A
authors: Pálinkás
authors: Mattia
authors: M
authors: Tanga
authors: Noèmi
authors: N
authors: Gruber
authors: Claudio
authors: C
authors: Michelassi
authors: Albert
authors: A
authors: Varga
authors: Alessandro
authors: A
authors: Bonzano
authors: Nicola
authors: N
authors: Gandolfo
authors: László
authors: L
authors: Halmai
authors: Antonia
authors: A
authors: Bassignana
authors: Muhammad Babar
authors: MB
authors: Imran
authors: Fabrizio
authors: F
authors: Delnevo
authors: Miklós
authors: M
authors: Csanády
authors: Eugenio
authors: E
authors: Picano
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D001783:Blood Flow Velocity; D018619:Echocardiography, Doppler, Pulsed; D017548:Echocardiography, Transesophageal; D004554:Electric Countershock; D005260:Female; D005424:Flecainide / Q000627:therapeutic use; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012008:Recurrence; D012680:Sensitivity and Specificity; D013318:Stroke Volume
chemical_list: D000889:Anti-Arrhythmia Agents; D005424:Flecainide