title: Low left atrial appendage flow velocity predicts recurrence of atrial fibrillation after catheter ablation of persistent atrial fibrillation.
abstract: BACKGROUND
  Recurrence after catheter ablation of persistent atrial fibrillation (AF) remains an unsolved issue. This study aimed to explore the association between the left atrial appendage peak flow velocity (LAAV) and AF recurrence after ablation in persistent AF patients.
  
  
  METHODS
  Fifty-three consecutive patients who underwent an initial catheter ablation of persistent AF were enrolled [age, 65±10 years; male, 42 (79%)]. The LAAV was obtained by transesophageal echocardiography before ablation. All the patients underwent pulmonary vein isolation and were followed up for 12 months. The LAAV and other clinical factors (AF duration, CHA2DS2VASc score, left atrial diameter, left atrial volume, and left ventricular ejection fraction) were tested using a Cox proportional hazards regression analysis as predictors of AF recurrence during the 1-year follow-up.
  
  
  RESULTS
  AF recurrence occurred in 16 (30%) patients. The patients with AF recurrences had lower LAAVs (23.3±7.2cm/s vs. 33.3±15.1cm/s, p=0.002) than those without AF recurrence. In the multivariable analysis, a low LAAV independently predicted AF recurrence (hazard ratio, 3.04; 95% confidence interval, 1.05-8.79; p=0.040). A Kaplan-Meier analysis also demonstrated a lower survival rate free from AF recurrence in the low LAAV group than in the high LAAV group (p=0.030).
  
  
  CONCLUSIONS
  A low LAAV was associated with AF recurrence after the initial catheter ablation of persistent AF.
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kanda
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan. Electronic address: masuda-masaharu@kanrou.net.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Masuda
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Sunaga
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Fujita
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Iida
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Okamoto
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Ishihara
authors.affiliation: Yao Munincipal Hospital, Yao, Osaka, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Takahara
authors.affiliation: Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sakata
authors.affiliation: Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Uematsu
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000503:physiopathology*; D001281:Atrial Fibrillation / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D016279:Atrial Function, Left / Q000502:physiology*; D001783:Blood Flow Velocity; D017115:Catheter Ablation / Q000009:adverse effects* / Q000401:mortality; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011667:Pulmonary Veins / Q000601:surgery; D012008:Recurrence; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Left atrial appendage flow velocity; Persistent atrial fibrillation; Radio frequency catheter ablation; Recurrence; Transesophageal echocardiography