Clinical value of left atrial appendage flow velocity for predicting of cardioversion success in patients with non-valvular atrial fibrillation

Background Echocardiographic parameters for predicting cardioversion outcom e in patients with non-valvular atrial fibrillation are not accurately defi ned. Objective To evaluate the role of left atrial appendage flow velocity detec ted by transoesophageal echocardiography for prediction of cardioversion ou tcome in patients with non-valvular atrial fibrillation enrolled in a prosp ective, multicentre, international study. Methods Four hundred and eight patients (257 males, mean age: 66 +/- 10 yea rs) with non-valvular atrial fibrillation lasting more than 48 h but less t han 1 year underwent transthoracic echocardiography and transoesophageal ec hocardiography before either electrical (n=324) or pharmacological (n=84) c ardioversion. Results Cardioversion was successful in restoring sinus rhythm in 328 (80%) and unsuccessful in 80 patients (20%). Mean left atrial appendage peak emp tying flow velocity was significantly higher in patients with successful th an in those with unsuccessful cardioversion (32(.)4 +/- 17(.)7 vs 23(.)5 +/ - 13(.)6 cm . s(-1); P <0(.)0001). At multivariate logistic regression anal ysis, three parameters proved to be independent predictors of cardioversion success: the atrial fibrillation duration <2 weeks (P=0(.)011, OR=4(.)9. C I 95%= 1(.)9-12(.)7). the mean left atrial appendage flow velocity > 31 cm. s(-1) (P=0(.)0013, OR=2(.)8 CI 95%= 1(.)5-5(.)4) and the left atrial diame ter < 47mm (P=0(.)093, OR=2(.)0, CT 95%=1(.)2-3(.)4), These independent pre dictors of cardioversion success outperformed other univariate predictors s uch as left ventricular end-diastolic diameter < 58 mm, ejection fraction > 56% and the absence of left atrial spontaneous echo contrast. Conclusion I n patients with non-valvular atrial Fibrillation. measurement of the left a trial appendage flow velocity profile by transoesophageal echocardiography before cardioversion provides valuable information for prediction of cardio version outcome. (C) 2001 The European Society of Cardiology.