Left atrial function assessed with Doppler echocardiography rather than left atrial volume predicts recurrence in patients with paroxysmal atrial fibrillation

Abstract

BACKGROUND: Paroxysmal atrial fibrillation (AF) (PaAF) could be a singleself-terminating episode of AF or recurrent ones ultimately resulting in a morepersistent form after sinus conversion. However, predictors of PaAF recurrencestill remain to be undetermined. Therefore, we investigated predictors ofrecurrence in patients with PaAF.METHODS: The study population included 228 PaAF patients (131 men, age64±14 years) who underwent transthoracic echocardiography immediately aftersinus conversion at initial diagnosis. We followed study patients for recurrenceof AF. Clinical characteristics and echocardiographic parameters werecompared between recurrence and non-recurrence group.RESULTS: Mean follow up duration was 18±28 months. Among 228 patients,recurrence of AF was demonstrated in 45 patients (20%, age 68±13 years) aftersinus conversion. Clinical characteristics were grossly similar between twogroups. However, recurrence group had larger left atiral (LA) volume index(LAVI, 32±12 vs. 25±10 ml/m2, P<0.001), Left ventricle mass index (LVMI,107±34 vs. 93±25 g/m2, P=0.012), E/E’ (14±7 vs. 12±5, P=0.012) and higherright ventricular systolic pressure (RVSP, 31±12 vs. 27±10 mmHg, P=0.053).Early diastolic mitral annular velocity (E’, 5±2 vs. 6±3 cm/s, P=0.021), latediastolic mitral annular velocity (A’, 7±2 vs. 9±2 cm/s, P<0.001), and peaksystolic mitral annular velocity (S’, 7±2 vs. 8±2 cm/s, P=0.045) weresignificantly lower in recurrence group. In multivariate Cox regression analysis,lower LVEF (Hazard ratio 0.944, 95% Confidential Interval 0.901-0.989,P=0.015), larger LVEDD (Hazard ratio 1.108, 95% Confidential Interval1.004-1.224, P=0.042) and lower A’ (Hazard ratio 0.492, 95% ConfidentialInterval 0.347-0.697, P<0.001) were independently significant predictors ofPaAF recurrence.CONCLUSION: Late diastolic mitral annular velocity (A’) which indicates LAsystolic function after sinus conversion was the independent predictor of PaAFrecurrence, whereas LA volume was not. LA function may be more importantthan LA volume in predicting recurrence particularly in patients with PaAF.