Author + information
- Carola Gianni,
- Sanghamitra Mohanty,
- Chintan Trivedi,
- Rong Bai,
- Amin Al-Ahmad,
- John Burkhardt,
- G. Gallinghouse,
- Patrick Hranitzky,
- Rodney Horton,
- Javier Sanchez,
- Luigi Di Biase and
- Andrea Natale
Background: LAA isolation has emerged as an ablation strategy to prevent arrhythmia recurrences in non-paroxysmal AF. It is not clear if echocardiographic assessment of LAA function can predict persistence of LAA isolation.
Methods: This is a retrospective case-control study of patients who underwent a redo procedure after LAA isolation and had a TEE performed between the two procedures. According to the presence or absence of LAA electrical activity, patients were classified into persistent LAA isolation (LAAi) or LAA reconnection (LAAr). PW Doppler-derived LAA flow velocities ≥ 40 cm/s were considered normal.
Results: 71 patients were analyzed. At the time of redo, 39 (55%) were found to have LAAi, while 32 (45%) had LAAr. 36 (92%) of 39 patients with LAAi and 14 (44%) of 32 patients with LAAr had low LAA flow velocities (Figure).
The sensitivity of low LAA flow velocities for persistent LAAi was 92% (95% CI 79%-98%) and the specificity 56% (95% CI 38%-74%). The positive predictive value was 72% (95% CI 58%-84%), while the negative predictive value was 86% (95% CI 64%-97%), with a positive likelihood ratio of 2.1 and a negative likelihood ratio of 7.3.
Conclusions: After LAA isolation, a low LAA flow is sensitive to predict persistent LAAi, with a high NPV. However, it lacks specificity: patients can have both LAAr with low flow (related to the high prevalence of LAA dysfunction in this population), and LAAi with normal flow (due to the presence of passive early diastolic LAA emptying secondary to ventricular contraction).
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Atrial Fibrillation and VT: Incorporating Novel Risks Toward Decision Making
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1280-109
- 2017 American College of Cardiology Foundation