Application Of Two-dimensional And Three-dimensional Transesophageal Echocardiography In The Classification Of Left Atrial Appendage Function In Patients With Atrial Fibrillation Undergoing One-station Procedures Of Catheter Ablation And Left Atrial Appen

ObjectiveTransesophageal echocardiography(TEE)has been widely used to assess the anatomy,thrombogenesis and function of left atrial appendage(LAA)in patients with atrial fibrillation(AF).At the present study,the TEE was used to classify the relationship between LAA function and the incidence of LAA thrombosis in AF patients,to assess the value in the selection of AF patients undergoing one station procedures of catheter ablation and LAA occlusion(CA-LAAO),and to observe the changes of LAA and pulmonary vein ridge(LAAR)during perioperative period and its relationship with residual peri-device leak of LAA occluder.MethodsA total of 2156 patients with AF who visited our hospital from October 2016 to March 2019 were selected,in whom 1,228 patients with paroxysmal AF(Group A)and 928 patients with persistent AF(Group B).In addition,20 patients without either AF or structural heart disease were chosen as a control group(Group C).The perioperative and follow-up data by TEE in 61 patients undergoing one station procedures of CA-LAAO(Group D)were analyzed.The left atrial diameter(LAD),left ventricular diameter(LVD),left ventricularejection fraction(LVEF),LAA orifice diameter(LAA-D),LAA length(LAA-L),LAA end-systolic volume(LAA-ESV),LAA end-diastolic volume(LAA-EDV),LAA volume change rate(LAA-VCR),LAA peak flow emptying velocity(LAA-PEV)among patients in Group A,B,and C using TEE were measured.The classification of LAA function is defined as follow: LAA-PEV> 0.40m/s is regarded as normal LAA function,LAA-PEV between 0.40m/s-0.30m/s as slight decrease in LAA function,and LAA-PEV between 0.29m/s-0.20m/s as moderate LAA reduction,and LAA-PEV less than 0.20m/s as severe reduction of LAA.The perioperative dynamic observation was performed on the patients in Group D,and the LAA ridge(LAAR)thickness,perimeter,and cross-sectional area were measured before operation,immediately after operation,3 months and 12 months after operation.The relationship between LAAR changes and residual peri-device leak of LAA occlude in Group D was observed with TEE at different time periods.ResultsThe patients in Group B had more likely decreased LAA-PEV and LAA-VCR than those in group A.The comparison between groups was highly correlated with LAA-VCR and LAA-PEV(correlation coefficient was 0.634,P =0.028).In patients with normal LAA function,slight decrease LAA function,moderate and severe decrease LAA function,the incidence of LAA thrombosis was 0.9%,4.4% and 33.3% respectively.3D-TEE observation showed that patients in group D had hyperemia and swelling of different degrees immediately after operation compared with preoperative LAAR.The thickness,perimeter,and cross-sectional area of LAAR recovered to the preoperative levels at three months after operation,that is,the swelling disappeared.Six of the 61(9.8%)CA-LAAO patients(the WATCHMAN occluders were implanted in all the patients)had residual shunts immediately after operation,of which 4had residual shunts ≤ 3mm,and 2had residual shunts of 4-5mm.There were 10 of 61 cases(16.4%)of had ≤3mm residualshunts and 1 case had thrombus detected on the device surface eat three-month follow-up.Three of 20 patients(4.9%)had residual shunts at 12-month follow-up.Conclusions1.TEE monitoring LAA function has an important guiding significance for predicting LAA thrombus formation.2.LAA-PEV and LAA-VCR in patients with persistent atrial fibrillation are important indicators for non-invasive evaluation of left atrial appendage function classification,and LAA-PEV can be more quickly and intuitively evaluated.The patients with persistent AF have lower left atrial function than those with paroxysmal AF.3.The incidence of mural thrombosis is significantly higher in AF patients with moderate and severe decreased LAA function.4.LAAR showed transient congestive swelling after CA-LAAO,and the swelling disappeared after three months of follow-up.5.LAAR thickness changes in the CA-LAAO procedure in the treatment of AF may be related to the presence of temporary residual shunts around the LAA occluder.During a long term follow-up,the incidence of residual shunts significantly decreased.