title: Clinical impact of quantitative left atrial vortex flow analysis in patients with atrial fibrillation: a comparison with invasive left atrial voltage mapping.
abstract: Recently, left atrial (LA) vortex flow analysis using contrast transesophageal echocardiography (TEE) has been shown to be feasible and has demonstrated significant differences in vortex flow morphology and pulsatility between normal subjects and patients with atrial fibrillation (AF). However, the relationship between LA vortex flow and electrophysiological properties and the clinical significance of LA vortex flow are unknown. The aims of this study were (1) to compare LA vortex flow parameters with LA voltage and (2) to assess the predictive value of LA vortex flow parameters for the recurrence of AF after radiofrequency catheter ablation (RFCA). Thirty-nine patients with symptomatic non-valvular AF underwent contrast TEE before undergoing RFCA for AF. Quantitative LA vortex flow parameters were analyzed by Omega flow (Siemens Medical Solution, Mountain View, CA, USA). The morphology and pulsatility of LA vortex flow were compared with electrophysiologic parameters that were measured invasively. Hemodynamic, electrophysiological, and vortex flow parameters were compared between patients with and without early recurrence of AF after RFCA. Morphologic parameters, including LA vortex depth, length, width, and sphericity index were not associated with LA voltage or hemodynamic parameters. The relative strength (RS), which represents the pulsatility power of LA, was positively correlated with LA voltage (R = 0.53, p = 0.01) and LA appendage flow velocity (R = 0.73, p < 0.001) and negatively correlated with LA volume index (R = -0.56, p < 0.001). Patients with recurrent AF after RFCA showed significantly lower RS (1.7 ± 0.2 vs 1.9 ± 0.4, p = 0.048) and LA voltage (0.9 ± 0.7 vs 1.7 ± 0.8, p = 0.004) than patients without AF recurrence. In the relatively small LA dimension group (LA volume index ≤ 33 ml/m(2)), RS was significantly lower (2.1 ± 0.3 vs 1.7 ± 0.1, p = 0.029) in patients with the recurrent AF. Quantitative LA vortex flow analysis, especially RS, correlated well with LA voltage. Decreased pulsatility strength in the LA was associated with recurrent AF. LA vortex may have incremental value in predicting the recurrence of AF.
authors.affiliation: Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jung Myung
authors.initials: JM
authors.lastname: Lee
authors.forename: Geu-Ru
authors.initials: GR
authors.lastname: Hong
authors.forename: Hui-Nam
authors.initials: HN
authors.lastname: Pak
authors.forename: Chi Young
authors.initials: CY
authors.lastname: Shim
authors.forename: Helene
authors.initials: H
authors.lastname: Houle
authors.forename: Mani A
authors.initials: MA
authors.lastname: Vannan
authors.forename: Minji
authors.initials: M
authors.lastname: Kim
authors.forename: Namsik
authors.initials: N
authors.lastname: Chung
mesh_terms: D000200:Action Potentials; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D016279:Atrial Function, Left; D062185:Atrial Pressure; D017115:Catheter Ablation; D003287:Contrast Media; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005466:Fluorocarbons; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011673:Pulsatile Flow; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D005466:Fluorocarbons; C042852:perflutren