title: Predicting favourable outcomes in the setting of radiofrequency catheter ablation of long-standing persistent atrial fibrillation: a pilot study assessing the value of left atrial appendage peak flow velocity.
abstract: BACKGROUND
  Catheter ablation is an effective and potentially curative treatment in patients with atrial fibrillation (AF).
  
  
  OBJECTIVE
  To test the hypothesis that left atrial appendage peak flow velocity (LAV) assessed by echocardiography can accurately predict successful catheter ablation as well as favourable outcome in the setting of long-standing persistent AF.
  
  
  METHODS
  This prospective pilot study enrolled 40 patients with long-standing persistent AF (age 60 ± 11 years; persistence of AF 4.2 ± 2 years) who underwent a first catheter ablation procedure using a standardized sequential stepwise protocol. LAV was assessed before the catheter ablation procedure along with classical factors (age, sex, left atrial area, AF cycle length, AF duration and left ventricular ejection fraction), all of which were tested using logistic regression for ability to predict restoration of sinus rhythm during catheter ablation as well as absence of recurrence during a 1-year follow-up.
  
  
  RESULTS
  Eighteen patients (45%) experienced AF termination during the procedure and 18 patients (45%) did not develop any recurrence during the first 12 months. Multivariable analysis demonstrated that high LAV (>0.3 m/s) was the only independent predictor of AF termination (odds ratio 5.91, 95% confidence interval 1.06-32.88; P=0.04) and absence of recurrence at 1 year (odds ratio 4.33, 95% confidence interval 1.05-17.81; P=0.04).
  
  
  CONCLUSIONS
  This pilot study demonstrated the feasibility and importance of LAV measurement in the setting of long-standing persistent AF to predict successful catheter ablation and favourable mid-term outcome.
authors: Département de Rythmologie, Clinique Pasteur, Toulouse, France. scombes@clinique-pasteur.com
authors: Stéphane
authors: S
authors: Combes
authors: Sophie
authors: S
authors: Jacob
authors: Nicolas
authors: N
authors: Combes
authors: Nicole
authors: N
authors: Karam
authors: Arnaud
authors: A
authors: Chaumeil
authors: Benoit
authors: B
authors: Guy-Moyat
authors: Frédéric
authors: F
authors: Treguer
authors: Antoine
authors: A
authors: Deplagne
authors: Serge
authors: S
authors: Boveda
authors: Eloi
authors: E
authors: Marijon
authors: Jean-Paul
authors: JP
authors: Albenque
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016279:Atrial Function, Left; D017115:Catheter Ablation / Q000009:adverse effects; D016009:Chi-Square Distribution; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome