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Impact of low-voltage zones on the left atrial anterior wall on the reduction in the left atrial appendage flow velocity in persistent atrial fibrillation patients

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Abstract

Background

The reduction in the left atrial appendage (LAA) flow velocity is related to the presence of emboli in atrial fibrillation (AF) patients. The LAA is located on the left superior side of the left atrial (LA) anterior wall, and we investigated the relationship between the reduction in the LAA flow velocity (LAAFV) and low voltage zones (LVZs < 0.5 mV) on the LA anterior wall.

Methods

In 146 persistent AF patients, LAAFV measurements, by transesophageal echocardiography, and catheter ablation were performed. LA mapping was performed before ablation during sinus rhythm, and the locations of any anterior-LVZs were documented.

Results

Eighty-one patients had a documented LVZ on the LA anterior wall, and those with an LVZ had a significantly lower LAAFV compared to those without (anterior-LVZ(+) vs. anterior-LVZ(−) = 26 ± 11 vs. 34 ± 10 cm/s, p < 0.001), while no significant difference was observed when compared to the other LVZ regions. A low-LAAFV (≦ 20 cm/s) was observed in 36 patients, and the CHADS2-vasc score and existence of an anterior-LVZ were associated with a low-LAAFV. In patients with anterior-LVZs, the distance between the anterior-LVZ and LAA orifice correlated with a low LAAFV (r = 0.534, p < 0.001) as compared to the surface area of the anterior-LVZ (r = − 0.288, p = 0.009).

Conclusions

In persistent AF patients, an LVZ on the LA anterior wall was associated with a low LAAFV. In addition, an anterior-LVZ located near the LAA orifice was further related to a reduction in the LAAFV.

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Authors and Affiliations

  1. Department of Cardiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami Koshigaya, Koshigaya, Saitama, 343-8555, Japan

    Yuichi Hori, Shiro Nakahara, Naoki Nishiyama, Reiko Fukuda, Tomoaki Ukaji, Hirotsugu Sato, Yuri Koshikawa, Tetsuya Ishikawa, Sayuki Kobayashi, Yoshihiko Sakai & Isao Taguchi

  2. Department of Cardiovascular Medicine, Dokkyo Medical University, Tochigi, Japan

    Shu Inami

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  1. Yuichi Hori
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  2. Shiro Nakahara
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  3. Naoki Nishiyama
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  4. Reiko Fukuda
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Correspondence to Yuichi Hori.

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The authors declare that they have no conflict of interest.

Ethical approval

All patients underwent an electrophysiological study and catheter ablation under the approval of the institutional committee on human research at our institution.

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Hori, Y., Nakahara, S., Nishiyama, N. et al. Impact of low-voltage zones on the left atrial anterior wall on the reduction in the left atrial appendage flow velocity in persistent atrial fibrillation patients. J Interv Card Electrophysiol 56, 299–306 (2019). https://doi.org/10.1007/s10840-019-00532-z

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  • DOI: https://doi.org/10.1007/s10840-019-00532-z

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