Left Atrial Appendage Flow Cycle Length Is an Important Predictor of Sinus Rhythm Maintenance after Catheter Ablation of Persistent or Long-Standing Persistent Atrial Fibrillation

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Purpose: Rate of sinus rhythm (SR) maintenance after catheter ablation (CA) of persistent or long-standing persistent atrial fibrillation (perAF or ls-perAF) is inferior to paroxysmal AF. This is mainly associated with atrial remodeling, so we assumed we could select responder to CA of perAF or ls-perAF before procedure. We hypothesized left atrial appendage flow cycle length (LAAFCL) measured by trans-esophageal echocardiography (TEE) was related to the extent of atrial electrical remodeling. This time, we evaluated the relationship between the LAAFCL before procedure and the rate of SR maintenance after CA of perAF or ls-perAF. Methods: We selected 25 patients (age 60.6±9.2 years). TEE was performed during AF rhythm in all patients. All patients underwent extensive encircling pulmonary vein isolation. Substrate modifications were added as necessary. Results: 16 patients maintained SR, and 9 patients had recurrence of AF. SR maintenance group had significant longer LAAFCL (216.4±115.4 vs. 142.144±27.1 ms, p<0.05) than AF recurrence group. There were no significant differences between two groups in age (p=NS), left atrial diameter (p=NS), left ventricular ejection fraction (p=NS), left ventricular end-diastolic dimension (p=0.076), LAA peak flow velocity (p=0.105), CHADS2 score (p=0.141), follow up period (p=NS), and receiving AAD after procedure (p=NS). Conclusions: LAAFCL is useful to determine indication for CA of perAF or ls-perAF.