Left Atrial Appendage Outflow Velocity Index is Superior to Conventional Criteria for Prediction of Maintenance of Sinus Rhythm after Cardioversion. An Echocardiographic Study in Patients with Atrial Fibrillation of a Few Months' Duration

• Published in: Scandinavian cardiovascular journal : SCJ Vol. 35; no. 2; pp. 119 - 124
• Main Author: Anders Roijer, Carl J. Meurling, J. Eskilsson, B. Olsson
• Format: Journal Article
• Language: English
• Published: Copenhagen Informa UK Ltd 2001; Oslo Taylor & Francis; Stockholm Scandinavian University Press
• Subjects: Aged; Arrhythmia, Sinus - diagnosis; Arrhythmia, Sinus - physiopathology; Atrial Appendage - diagnostic imaging; Atrial Appendage - physiopathology; Atrial Fibrillation - diagnostic imaging; Atrial Fibrillation - physiopathology; Atrial Fibrillation - therapy; Atrial Function, Left; Biological and medical sciences; Blood Flow Velocity; Cardiac and Cardiovascular Systems; Cardiovascular system; Cardioversion Left Atrial Appendage Outflow Velocity Sinus Rhythm Transesophageal Echocardiography; Clinical Medicine; Echocardiography, Doppler; Echocardiography, Transesophageal; Electric Countershock; Female; Heart Rate; Humans; Investigative techniques, diagnostic techniques (general aspects); Kardiologi; Klinisk medicin; Male; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Predictive Value of Tests; Ultrasonic investigative techniques; Sonography; Human; Intensive cardiocirculatory care; Regional blood flow; Relapse; Echocardiography; Arrhythmia; Pathophysiology; Treatment efficiency; Atrial fibrillation; Instrumentation therapy; Left auricular appendage; Cardiovascular disease; Cardioversion; Exploration; Excitability disorder; Analysis method; Treatment; Heart disease; Risk factor; Complication; Hemodynamics; Defibrillation; Predictive factor
• ISSN: 1401-7431; 1651-2006; 1651-2006
• DOI: 10.1080/140174301750164817

Objective - To investigate whether left atrial appendage outflow velocity alone or in relation to left atrial diameter is a superior predictor of sinus rhythm maintenance after cardioversion compared with traditional clinical or echocardiography parameters. Design - Sixty-two patients with their first episode of atrial fibrillation were examined using echocardiography before DC-cardioversion. At one month's follow-up, 42 patients had maintained sinus rhythm (group A), and 20 had relapsed into atrial fibrillation (group B). There were no differences in arrhythmia duration or antiarrhythmic therapy between the groups. Results - Left atrial diameter measured by echocardiography was smaller in group A (42 mm, 95% CI 40.9-44.1 mm) compared with group B (46 mm, 95% CI 43.4-48.2, p < 0.05). Patients in group A had a higher left atrial appendage outflow velocity at 0.44 m/s (95% CI 0.39-0.49) compared with 0.34 m/s (95% CI 0.30-0.37) in group B (p < 0.01). The ratio of left atrial appendage flow to left atrial diameter was 0.011 (95% CI 0.009-0.012) in group A compared with 0.008 (95% CI 0.007-0.009) in group B, and 63% (95% CI 33-78) of the patients in group A had velocity ratio >0.009 compared with 20% (95% CI 2-38) in group B, (p < 0.01). Stepwise multiple logistic regression analysis showed that a velocity ratio >0.009 was the only predictor for maintenance of sinus rhythm one month after cardioversion with an odds ratio of 6.4 (95% CI 1.9-23.8), (p = 0.004). Conclusion - The ratio of left atrial appendage outflow velocity to left atrial diameter is superior to the traditionally used criteria for prediction of maintenance of sinus rhythm following DC-conversion of first-episode atrial fibrillation.