P5654Brain natriuretic peptide and left atrial volume predict the reduced flow velocity of left atrial appendage during sinus rhythm in patients with atrial fibrillation

• Published in: European heart journal Vol. 40; no. Supplement_1
• Main Authors: Fukuhara, E, Mine, T, Kishima, H, Ashida, K, Ishihara, M
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01.10.2019
• Subjects: Oral Anticoagulation
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehz746.0597

Abstract Background It remains controversial whether or not to discontinue anticoagulation therapy after catheter ablation (CA) for atrial fibrillation (AF). The reduced flow velocity of the left atrial appendage (FV-LAA) during AF causes left atrial appendage thrombus and increases the risk of stroke. However, some AF patients show reduced FV-LAA even during sinus rhythm (SR). Methods 398 patients who showed SR during transesophageal echocardiography (TEE) before CA for AF were studied (259 males, 68±10 years, 77 with non-paroxysmal AF). Clinical factors, transthoracic echocardiography and blood samples were obtained before TEE. Reduced FV-LAA was defined as <35 cm/sec of FV-LAA. Results Reduced FV-LAA was observed 70/398 patients (18%). Reduced FV-LAA was significantly associated with elevated brain natriuretic peptide (BNP) (p<0.0001), increased LA volume index (p<0.0001), reduced left ventricular ejection fraction (p=0.0017), high prevalence of non-paroxysmal AF (p=0.0048), prior history of heart failure (p=0.0172), and no administration of angiotensin converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB) (p=0.0403), while CHADS2 factors were not significantly associated. On multivariate analysis, LA volume index (p<0.0001, OR 1.049 for each 1 increase in LA volume index, 95% CI 1.025–1.073) and no administration of ACEI/ARB (p=0.0015, OR 0.339 for administration, 95% CI 0.173–0.662) and BNP (p=0.0048, OR 1.035 for each 10 pg/ml increase in BNP, 95% CI 1.011–1.061) and were associated with reduced FV-LAA. Rate of reduced flow velocity Conclusion The elevated BNP level and large LA volume index predict reduced FV-LAA during SR. AF patients with increased BNP and larger LA volume index might require long-term anticoagulation taking after CA procedure.