Left Atrial Appendage Outflow Velocity is Superior to Conventional Criteria for Predicting of Maintenance of Sinus Rhythm After Simple Cryoablation of Pulmonary Vein Orifices

Background We sought to identify factors favoring long-term restoration of sinus rhythm (SR) in patients with atrial fibrillation (AF) who underwent a simple cryoablation of pulmonary vein orifices (PV-cryo) as part of their cardiac surgery. Methods and Results Of 101 patients with AF undergoing PV-cryo, the 71 in SR at discharge were grouped according to whether they maintained or lost SR (group SR, n=61, and group AF, n=10) after an average of 2.3 years. Atrial fibrillation present at discharge (n=30) persisted during follow up. Comparisons were made to identify preoperative predictive factors, including transthoracic and transesophageal echocardiographic parameters. Of patients discharged from the hospital with SR, 92% (46 of 50) of those with AF duration of 3 years or less were in group SR, as were 92% (23 of 25) of those with left atrial dimension of 50mm or less, and 93% (37 of 40) of those with average peak left atrial appendage outflow velocities (LAA-V) of at least 30cm/s. Of 25 patients in group SR who had no paroxysmal AF and did not require antiarrhythmic drugs, all had LAA-V over 20 cm/s. Patients in group AF all had LAA-V under 40 cm/s. Conclusions Left atrial appendage outflow velocities was the best predictor of whether SR was maintained long-term after PV-cryo.