211 Clinical value of left atrial appendage flow for prediction of successful catheter ablation for persistent atrial fibrillation

Introduction The purpose of this study was to determine whether left atrial appendage flow velocity, as determined using trans esophageal echocardiography (TEE), predicts the outcome after catheter ablation of persistent atrial fibrillation (PAF). Method 40 PAF patients (85% males, 60 +/− 11 years) underwent a stepwise ablation approach. The procedural end point was termination of persistent AF by catheter ablation, either by conversion directly to sinus rhythm or to atrial tachycardia. Left atrial appendage (LAA) peak flow velocities were measured with transesophageal echography and averaged within each RR interval of 10 consecutive cardiac cycles. Others parameters LA area, left ventricular ejection fraction, duration of continuous AF, Administration of amiodarone, were analyzed to determine the factors associated with procedural termination of arrhythmia. Results Among the 40 patients, all received a circumferential PV isolation, a linear ablation, and a continuous CFE ablation. Atrial fibrillation was terminated in 26 patients (65%) with a mean procedure time of 201 min+/−43 min. The pre-procedural ejection fraction (p = 0.38), duration of continuous AF (p = 0.09) did not differ significantly between patients who had success of catheter ablation compared with those who had not. Peak emptying velocities of the LAA before catheter ablation were significantly higher in patients in whom PAF was terminated during the procedure (0.23 vs. 0.34, p = 0.002). On multivariate logistic regression analysis, only the mean LAA peak emptying velocity > 0.30 cm/s (p = 0.02, odds ratio [OR] = 9, 58 confidence interval [CI] 95% = 1.50 to 61.36), predicted successful catheter ablation for PAF. At 6 months follow-up, patients who underwent continued to have sinus rhythm, were significantly (p = 0, 003) higher in group who have LAA flow velocity > 0, 30. Conclusion High LAA flow velocity assessed by TEE is a clinically useful pre-ablation tool for predicting successful catheter ablation for persistent atrial fibrillation and maintenance of sinus rhythm.