Relationship Between Circulatory Stasis in the Left Atrial Appendage Detected by Cardiac Computed Tomography Angiography With Atrial Fibrillation Recurrence After Initial Catheter Ablation

Background To investigate the relationship between circulatory stasis in the left atrial appendage (LAA), as detected by cardiac computed tomography angiography, and atrial fibrillation (AF) recurrence after the initial catheter ablation. Methods In this single‐center prospective observational study, consecutive patients with nonvalvular AF scheduled for the initial catheter ablation were enrolled from August 2018 to June 2022. The primary end point was AF recurrence (any documented atrial tachyarrhythmia lasting for ≥30 seconds after a 3‐month blanking period) during 1 year after catheter ablation. Results Among the enrolled 548 patients (mean age 65.3±8.8 years and 64.2% men), 131 (23.9%) were with LAA circulatory stasis. Totally, 525 patients completed the 1‐year follow‐up. AF recurrence was observed in 39.1% (50/128) of patients with circulatory stasis and 19.4% (77/397) of patients without circulatory stasis. The presence of LAA circulatory stasis was significantly associated with AF recurrence (adjusted hazard ratio [HR], 2.41 [95% CI, 1.57–3.72]). The incorporation of circulatory stasis in the LAA significantly improved the predictive accuracy of conventional scoring systems for AF recurrence, with the areas under the curve increasing from 0.524 to 0.616 ( P =0.037) for the APPLE score, from 0.516 to 0.617 ( P =0.035) for the CAAP‐AF score, and from 0.532 to 0.619 ( P =0.001) for the CHA 2 DS 2 ‐VASc score. Conclusions In patients with nonvalvular AF, circulatory stasis in the LAA could serve as a predictor for AF recurrence following the initial ablation procedure.