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Original article
Published online: 2021-05-13
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Patent foramen ovale and left atrial appendage flow velocity predict atrial fibrillation recurrence post cryoballoon ablation

Grzegorz Kiełbasa, Agnieszka Bednarek, Adam Bednarski, Agnieszka Olszanecka, Tomasz Sondej, Aleksander Kusiak, Wiktoria Wojciechowska, Marek Rajzer, Marek Jastrzębski
DOI: 10.33963/KP.a2021.0004
·
Pubmed: 34002841

open access

Online first
Original article
Published online: 2021-05-13

Abstract

Background: Transesophageal echocardiography (TEE) allows detailed characterization of atrial fibrillation (AF) substrate and could be valuable for predicting pulmonary vein isolation (PVI) procedure outcomes.

Aims: We aimed to assess the value of TEE-derived left atrial (LA) and LA appendage (LAA) features as prognostic markers for AF recurrence after cryoballoon-based ablation.

Methods: Patients were enrolled using prospective database of consecutive PVI procedures performed over a 7-year period. Following TEE-derived parameters were investigated: LAA emptying flow velocity (LAA-FV), presence of patent foramen ovale (PFO), LA spontaneous echo contrast and mitral regurgitation. Diagnosis of AF recurrence was based on scheduled and symptoms triggered ECG monitoring. Cox’s regression model and Kaplan-Meier survival curves were applied for statistical analysis.

Results: A total of 417 consecutive patients who underwent their first PVI using cryoballoon were analysed (mean age: 59 years). AF recurrence was noted in 25.7 % of patients (median follow-up of 24 months). Four TEE-derived variables had predictive value for AF recurrence: LAA-FV < 45 cm/s, presence of PFO at resting state, LA spontaneous echo contrast and mitral regurgitation. In the multivariable model, apart from the transthoracic echocardiography-derived LA size, two TEE-derived features (LAA-FV < 45 cm/s and presence of PFO) remained as independent predictors.

Conclusions: This study proposed a novel TEE-derived AF recurrence risk factor - presence of PFO and confirmed the prognostic value of LAA flow velocity in patients undergoing cryoballoon-based AF ablation. These risk factors could be useful in global assessment of AF recurrence risk and potentially helpful in planning the ablation strategy.

Abstract

Background: Transesophageal echocardiography (TEE) allows detailed characterization of atrial fibrillation (AF) substrate and could be valuable for predicting pulmonary vein isolation (PVI) procedure outcomes.

Aims: We aimed to assess the value of TEE-derived left atrial (LA) and LA appendage (LAA) features as prognostic markers for AF recurrence after cryoballoon-based ablation.

Methods: Patients were enrolled using prospective database of consecutive PVI procedures performed over a 7-year period. Following TEE-derived parameters were investigated: LAA emptying flow velocity (LAA-FV), presence of patent foramen ovale (PFO), LA spontaneous echo contrast and mitral regurgitation. Diagnosis of AF recurrence was based on scheduled and symptoms triggered ECG monitoring. Cox’s regression model and Kaplan-Meier survival curves were applied for statistical analysis.

Results: A total of 417 consecutive patients who underwent their first PVI using cryoballoon were analysed (mean age: 59 years). AF recurrence was noted in 25.7 % of patients (median follow-up of 24 months). Four TEE-derived variables had predictive value for AF recurrence: LAA-FV < 45 cm/s, presence of PFO at resting state, LA spontaneous echo contrast and mitral regurgitation. In the multivariable model, apart from the transthoracic echocardiography-derived LA size, two TEE-derived features (LAA-FV < 45 cm/s and presence of PFO) remained as independent predictors.

Conclusions: This study proposed a novel TEE-derived AF recurrence risk factor - presence of PFO and confirmed the prognostic value of LAA flow velocity in patients undergoing cryoballoon-based AF ablation. These risk factors could be useful in global assessment of AF recurrence risk and potentially helpful in planning the ablation strategy.

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Keywords

atrial fibrillation recurrence; cryoballoon ablation; patent foramen ovale; left atrial appendage flow velocity

About this article
Title

Patent foramen ovale and left atrial appendage flow velocity predict atrial fibrillation recurrence post cryoballoon ablation

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2021-05-13

DOI

10.33963/KP.a2021.0004

Pubmed

34002841

Keywords

atrial fibrillation recurrence
cryoballoon ablation
patent foramen ovale
left atrial appendage flow velocity

Authors

Grzegorz Kiełbasa
Agnieszka Bednarek
Adam Bednarski
Agnieszka Olszanecka
Tomasz Sondej
Aleksander Kusiak
Wiktoria Wojciechowska
Marek Rajzer
Marek Jastrzębski

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