P1028Left atrial function assessed with doppler echocardiography rather than left atrial volume predicts recurrence in patients with paroxysmal atrial fibrillation

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Background: Paroxysmal atrial fibrillation (AF) (PaAF) could be a single self-terminating episode of AF or recurrent ones ultimately resulting in a more persistent form after sinus conversion. However, predictors of PaAF recurrence still remain to be undetermined. Therefore, we investigated predictors of recurrence in patients with PaAF.Methods: The study population included 228 PaAF patients (131 men, age 64±14 years) who underwent transthoracic echocardiography immediately after sinus conversion at initial diagnosis. We followed study patients for recurrence of AF. Clinical characteristics and echocardiographic parameters were compared between recurrence and non-recurrence group.Results: Mean follow up duration was 18±28 months. Among 228 patients, recurrence of AF was demonstrated in 45 patients (19.7%, age 68±13 years) after sinus conversion. Baseline characteristics were grossly similar between two groups. However, recurrence group had larger left atiral (LA) volume index (LAVI, 33±23 vs. 25±10 ml/m2, P<0.001), higher right ventriclular systolic pressure (RVSP, 31±12 vs. 27±10 mmHg, P=0.049). Early diastolic mitral annular velocity (E', 5±2 vs. 6±3 cm/s, P=0.021), late diastolic mitral annular velocity (A', 7±3 vs. 9±6 cm/s, P=0.042), and peak systolic mitral annular velocity (S', 7±2 vs. 8±2 cm/s, P=0.026) were significantly lower in recurrence group. In multivariate Cox regression analysis, Left ventricle(LV) ejection fraction(EF) was lower (Hazard ratio 0.942, 95% Confidential Interval 0.901-0.984, P=0.007) and LV end diastolic dimension was higher(Hazard ratio 1.106, 95% Confidential Interval 1.009-1.214, P=0.032)in recurrence group. A' was the most independent predictor of PaAF recurrence (Hazard ratio 0.502, 95% Confidential Interval 0.362-0.695, P=0.001).Conclusion: Late diastolic mitral annular velocity (A') which indicates LA systolic function after sinus conversion was the most independent predictor of PaAF recurrence, whereas LA volume was not. LA function is superior to LA volume in predicting recurrence in patients with relatively early stage of AF like PaAF.

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