210: Predicting Favorable Outcomes in the Setting of Radiofrequency Catheter Ablation of Persistent Atrial Fibrillation - A Pilot Study Assessing the Value of Left Atrial Appendage Peak Flow Velocity

AimsWe hypothesized that left atrial appendage peak flow velocity (LAV) assessed by echocardiography was able to accurately predict successful catheter ablation as well as favorable outcome in the setting of long-standing persistent atrial fibrillation (AF).MethodsThis prospective pilot study enrolled 40 patients with long-standing persistent AF (age 60±11 years, persistence of AF 4.2±2 years) who underwent first catheter ablation procedure, using a standardized sequential stepwise protocol. LAV was assessed prior to catheter ablation procedure besides classical factors (age, gender, left atrial area, AF cycle length, AF duration, and left ventricular ejection fraction), and were tested using logistic regression for (i) restoration of sinus rhythm during catheter ablation as well as (ii) absence of recurrence during a one-year follow-up.ResultsEighteen patients (45%) experienced AF termination during the procedure, and 18 patients (45%) did not develop any recurrence during the first 12-months. Multivariate analysis demonstrated that high LAV (>0.3 m. s-1) was the only independent predictor of AF termination (OR=5.91, 95%CI: 1.06-32.88, p=0.04) and absence of recurrence at one year (OR=4.33, 95%CI: 1.05-17.81, p=0.04).TableResultsCharacteristicUnivariate analysis OR [95%CI]p valueMultivariate analysis OR [95%CI]p valueAge ≥65 years0.84 [0.23-3.02]0.79Duration of AF < 25 months1.97[0.51–7.05]0.33LAV >0.30 m/s5.14 [1.30–20.36]0.024.33 [1.05-17.81]0.04LVEF >60%2.20 [0.60-8.08]0.26Left atrial area < 25 cm21.56 [0.43-5.64]0.50AFCL >175 ms3.06 [0.82-11.44]0.092.25 [0.55-9.28]0.26ConclusionsThis pilot study demonstrated the feasibility and the importance of LAV measurement in the setting of long-standing persistent AF in order to predict successful catheter ablation and favorable mid-term outcome