Usefulness of Left Atrial Emptying Fraction to Predict Ventricular Arrhythmias in Patients With Implantable Cardioverter-Defibrillators

Abstract Impaired left atrial emptying fraction (LAEF) is an important predictor of mortality in heart failure patients. As it may reflect increased LV wall stress, it might predict ventricular arrhythmia (VA) specifically. This study evaluated the predictive value of LAEF assessed with cardiac magnetic resonance imaging (CMR) with respect to appropriate device therapy (ADT) for VA and compared its role with CMR assessed scar size and other risk factors. In total, 229 patients (68% male, 63±10 years, 61% ischemic cardiomyopathy) with LV ejection fraction ≤35% who underwent CMR and ICD implantation for primary prevention in 2005-2012 were included. CMR was used to quantify LV volumes and function. LV scar size was quantified when late gadolinium enhancement was available (n=166). Maximum and minimum left atrial volumes (LAVmax and LAVmin), and LAEF were calculated using the biplane area-length method. The occurrence of ADT and mortality was assessed during a median follow-up of 3.9 years. Sixty-two (27%) patients received ADT. Univariable Cox analysis showed that male gender, creatinine level, LAVmin, LAEF, and total scar size were significant predictors of ADT. In multivariable Cox analysis, LAEF (HR 0.75 per 10%, P median and scar size