The Predictive Value of the Left Atrial Kinetic Energy for Atrial Fibrillation Recurrence

Abstract

Background and aim Determining which patients will experience recurrence of atrial fibrillation (AF) is crucial for treatment modification. This study aimed to investigate the predictive value of left atrial kinetic energy (LAKE) in AF recurrence. Materials and methods A total of 120 consecutive patients who achieved sinus rhythm (SR) with electrical direct current cardioversion and met the inclusion criteria were included in the study. Transthoracic echocardiography (TTE) and LAKE values were calculated on the first day after cardioversion. Rhythm control was performed with 12-lead electrocardiography in the first-month follow-up. Results While 81 (67.5%) patients were in SR at one month, AF recurrence was detected in 39 (32.5%) patients. In the AF group, AF duration, cardioversion energy, number of diabetic patients, left atrium (LA) diameter, LA pre-mitral A wave volume, LA minimum volume, and pulmonary artery pressure values were significantly higher than in the SR group, while mitral A wave velocity and LAKE values were significantly lower. In multivariate regression analysis, AF duration (OR: 1.54; 95% CI: 1.22 - 1.93; p < 0.001), LA diameter (OR: 1.33; 95% CI: 1.10 - 1.61; p = 0.002), and LAKE (OR: 0.96; 95% CI: 0.94 - 0.99; p = 0.007) were determined to be independent predictors of AF recurrence at one month. Conclusions LA diameter, AF duration, and LAKE were found to be significant predictors of AF recurrence after cardioversion.

Keywords: atrial fibrillation; cardioversion; echocardiography; left atrial kinetic energy; recurrence.

Figure 1. (A) Maximal LA volume just before the opening of the mitral valve at end-systole (ECG: at the end of the T wave). (B) Pre-A LA volume just before atrial systole (ECG: at the beginning of P wave). (C) Minimal LA volume at end-diastole when the mitral valve is closed (ECG: at the beginning of QRS)

LA, left atrium.