Left atrial size, spontaneous contrast, and atrial appendage peak flow velocity in relation to duration of atrial fibrillation

Objective: Clinical predictors of ischemic stroke in the setting of atrial fibrillation (AF) have been identified, but there is limited data on predictors in the context of abnormal flow originating from the left atrial appendage. We hypothesize that reduced LAA flow velocity is associated with cerebrovascular ischemic events in patients with AF. Methods: We investigated consecutive patients with AF evaluated for ablation. Peak flow velocities at the orifice of the left atrial appendage (LAA) were obtained by transeosphageal echocardiography (TEE) studies, and elevated velocities were defined as greater than 40 cm/sec, in line with prior studies. The primary outcome was defined as the presence of any of the following: history of stroke/transient ischemic event, or non-lacunar brain infarct on brain imaging performed before the TEE. Univariate and multivariable analyses were performed to determine the association between LAA peak flow and the primary outcome, adjusting for CHADS2Vasc score. Results: We identified 322 patients with TEE performed. The mean age was 62.1 years and 24.5% men. Patients with LAA-flow velocity < 40 cm/sec were more likely to have the primary outcome (10.7% vs 4.3%, p=0.023). This association persisted after adjusting for CHADS2VASc (OR, 2.62; 95% CI, 1.09-6.33, p = 0.032). Conclusion: Low velocity in the LAA is associated with cerebrovascular ischemic events in patients with AF. More studies are needed to deterine whether LAA flow velocity can help risk stratify “low risk” patients with AF.

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Trans-oesophageal Echocardiographic Appraisal of Left Atrial Appendage Clot in Severe Mitral Stenosis.

Nepalese Heart Journal ◽

10.3126/njh.v10i1.9744 ◽

2014 ◽

Vol 10 (1) ◽

pp. 27-29

Author(s):

Rabindra Simkhada ◽

Man Bahadur KC ◽

Yadav Deo Bhatt ◽

Arun Maskey ◽

Rabi Malla ◽

...

Keyword(s):

Atrial Fibrillation ◽

Mitral Stenosis ◽

Left Atrial ◽

Left Atrial Appendage ◽

Transoesophageal Echocardiography ◽

Atrial Appendage ◽

Clot Formation ◽

Left Atrial Size ◽

Atrial Size ◽

Percutaneous Transvenous Mitral Commissurotomy

Background and Aims Left atrial appendage clot is a common complication of mitral stenosis. The management of patient differs significantly if there is presence of clot. Various factors had been studied as a risk factor for clot formation. We aim to assess the prevalence of left atrial appendage clot by trans-oesophageal echocardiography in patients of severe mitral stenosis planned for percutaneous transvenous mitral commissurotomy and analyze the factors responsible for it. Methods: An oservational prevalence study was conducted among 100 patients of severe mitral stenosis who were undergoing transoesophageal echocardiography before percutaneous transvenous mitral commissurotomy and prevalence of left atrial appendage clot were recorded. Data were entered in the SPSS and factors responsible for clot formation were analyzed. Results: Out of 100 enrolled patients, 69 (69%) were female. Mean age of presentation was 37.4±13.70 years. Mean age of female was 38.11±13.13 years and male was 35.80±14.98 years. Mean mitral valve area was 0.87±0.12 cm2 and mean left atrial size was 4.79±0.60 cm. Atrial Fibrillation was present in 32 (32%) patients. Transoesophageal echocardiography revealed left atrial appendage clot in 28 (28%). Gender showed no correlation with presence of clot (p=0.06). Increasing age (p=0.002), presence of Atrial Fibrillation (p=0.005) and larger left atrial size (p<0.01) showed significant positive correlation with left atrial appendage clot formation. Conclusion: Left atrial appendage clot was common finding in severe mitral stenosis patients. Patients with advanced age, presence of atrial fibrillation and larger left atrial size were more likely to have clot formation. Nepalese Heart Journal | Volume 10 | No.1 | November 2013| Pages 27-29 DOI: http://dx.doi.org/10.3126/njh.v10i1.9744

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Identification of Hypertersive Patients With Atrial Fibrillation: Left Atrial Size, Signal Averaged P-Wave, or Both?

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(97)84507-x ◽

1998 ◽

Vol 31 (2) ◽

pp. 184A

Author(s):

A Volgman

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

P Wave ◽

Left Atrial Size ◽

Atrial Size

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The Effect of Catheter Ablation on Left Atrial Size and Function for Patients with Atrial Fibrillation: An Updated Meta-Analysis

PLoS ONE ◽

10.1371/journal.pone.0129274 ◽

2015 ◽

Vol 10 (7) ◽

pp. e0129274 ◽

Cited By ~ 9

Author(s):

Bin Xiong ◽

Dan Li ◽

Jianling Wang ◽

Laxman Gyawali ◽

Jinjin Jing ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Left Atrial ◽

Meta Analysis ◽

Left Atrial Size ◽

Atrial Size ◽

And Function

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Altered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling

Scientific Reports ◽

10.1038/s41598-021-85176-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ahmet Demirkiran ◽

Raquel P. Amier ◽

Mark B. M. Hofman ◽

Rob J. van der Geest ◽

Lourens F. H. J. Robbers ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Flow Velocity ◽

Paroxysmal Atrial Fibrillation ◽

Left Atrial ◽

Peak Flow ◽

Thrombus Formation ◽

Clinical Value ◽

4D Flow ◽

Ssfp Cine

AbstractThe pathophysiology behind thrombus formation in paroxysmal atrial fibrillation (AF) patients is very complex. This can be due to left atrial (LA) flow changes, remodeling, or both. We investigated differences for cardiovascular magnetic resonance (CMR)-derived LA 4D flow and remodeling characteristics between paroxysmal AF patients and patients without cardiac disease. In this proof-of-concept study, the 4D flow data were acquired in 10 patients with paroxysmal AF (age = 61 ± 8 years) and 5 age/gender matched controls (age = 56 ± 1 years) during sinus rhythm. The following LA and LA appendage flow parameters were obtained: flow velocity (mean, peak), stasis defined as the relative volume with velocities < 10 cm/s, and kinetic energy (KE). Furthermore, LA global strain values were derived from b-SSFP cine images using dedicated CMR feature-tracking software. Even in sinus rhythm, LA mean and peak flow velocities over the entire cardiac cycle were significantly lower in paroxysmal AF patients compared to controls [(13.1 ± 2.4 cm/s vs. 16.7 ± 2.1 cm/s, p = 0.01) and (19.3 ± 4.7 cm/s vs. 26.8 ± 5.5 cm/s, p = 0.02), respectively]. Moreover, paroxysmal AF patients expressed more stasis of blood than controls both in the LA (43.2 ± 10.8% vs. 27.8 ± 7.9%, p = 0.01) and in the LA appendage (73.3 ± 5.7% vs. 52.8 ± 16.2%, p = 0.04). With respect to energetics, paroxysmal AF patients demonstrated lower mean and peak KE values (indexed to maximum LA volume) than controls. No significant differences were observed for LA volume, function, and strain parameters between the groups. Global LA flow dynamics in paroxysmal AF patients appear to be impaired including mean/peak flow velocity, stasis fraction, and KE, partly independent of LA remodeling. This pathophysiological flow pattern may be of clinical value to explain the increased incidence of thromboembolic events in paroxysmal AF patients, in the absence of actual AF or LA remodeling.

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