1. Dawber TR, Kannel WB, Lyell LP. An approach to longitudinal studies in a community: the Framingham Study. Ann NY Acad Sci 1963;107:539 –556. 2. The Boston Area Anticoagulation Trial for Atrial Investigators. The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation. N Engl J Med 1990;323:1505–1511. 3. Abbott RD, McGee DL. The Framingham Study: An Epidemiological Investiga- tion of Cardiovascular Disease, Section 37: The Probability of Developing Certain Cardiovascular Diseases in Eight Years at Specified Values of Some Characteristics. Bethesda, Maryland: National Heart, Lung, and Blood Institute, 1987. 4. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jr, Jones DW, Materson BJ, Oparil S, Wright JT, Jr, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003;289:2560 –2571. 5. Petersen P, Boysen G, Godtfredsen J, Andersen ED, Andersen B. Placebo- controlled, randomised trial of warfarin and aspirin for prevention of thrombo- embolic complications in chronic atrial fibrillation. The Copenhagen AFASAK Study. Lancet 1989;1:175–179. 6. Connolly SJ, Laupacis A, Gent M, Roberts RS, Carins JA, Joyner C. Canadian Atrial Fibrillation Anticoagulation (CAFA) study. J Am Coll Cardiol 1991;18:349 –355. 7. Stroke Prevention in Atrial Fibrillation Investigators. Stroke Prevention in Atrial Fibrillation Study: final results. Circulation 1991;84:527–539. 8. Ezekowitz MD, Bridgers SL, James KE, Carliner NH, Colling CL, Gornick CC, Krause-Steinrauf H, Kurtzke JF, Nazarian SM, Radford MJ, et al. Warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation. Vet- erans Affairs Stroke Prevention in Nonrheumatic Atrial Fibrillation Investigators. N Engl J Med 1992;327:1406 –1412. 9. Stafford RS, Singer DE. National patterns of warfarin use in atrial fibrillation. Arch Intern Med 1996;156:2537–2541. 10. Stafford RS, Singer DE. Recent national patterns of warfarin use in atrial fibrillation. Circulation 1998;97:1231–1233. 11. Go AS, Hylek EM, Borowsky LH, Phillips KA, Selby JV, Singer DE. Warfarin use among ambulatory patients with nonvalvular atrial fibrillation: the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study. Ann Intern Med 1999;131:927–934. 12. Bradley BC, Perdue KS, Tisdel KA, Gilligan DM. Frequency of anticoagu- lation for atrial fibrillation and reasons for its non-use at a Veterans Affairs Medical Center. Am J Cardiol 2000;85:568 –572. 13. Atrial Fibrillation Investigators. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials. Arch Intern Med 1994;154:1449 –1457. 14. Evans A, Kalra L. Are the results of randomized controlled trials on antico- agulation in patients with atrial fibrillation generalizable to clinical practice? (comment). Arch Intern Med 2001;161:1443–1447. 15. McMahan DA, Smith DM, Carey MA, Zhou XH. Risk of major hemorrhage for outpatients treated with warfarin. J Gen Intern Med 1998;13:311–316. 16. Landefeld CS, Goldman L. Major bleeding in outpatients treated with warfarin: incidence and prediction by factors known at the start of outpatient therapy. Am J Med 1989;87:144 –152. 17. Hylek EM, Singer DE. Risk factors for intracranial hemorrhage in outpatients taking warfarin. Ann Intern Med 1994;120:897–902. 18. Fihn SD, McDonell M, Martin D, Henikoff J, Vermes D, Kent D, White RH. Risk factors for complications of chronic anticoagulation: a multicenter study. Ann Intern Med 1993;118:511–520. 19. Van der Meer FJM, Rosendaal FR, Vandenbroucke JP, Briet E. Bleeding complications in oral anticoagulant therapy: an analysis of risk factors. Arch Intern Med 1993;153:1557–1562. 20. McCrory DC, Matchar DB, Samsa G, Sanders LL, Pritchett ELC. Physician attitudes about anticoagulation for nonvalvular atrial fibrillation in the elderly. Arch Intern Med 1995;155:277–281. Usefulness of Intracardiac Doppler Assessment of Left Atrial Function Immediately Post–Pulmonary Vein Antrum Isolation to Predict Short-Term Recurrence of Atrial Fibrillation Atul Verma, MD, Nassir F. Marrouche, MD, Hirotsugu Yamada, MD, Richard A. Grimm, DO, Jennifer Cummings, MD, J. David Burkhardt, MD, Fethi Kilicaslan, MD, Mandeep Bhargava, MD, Abdul-Ahmad Karim, MD, James D. Thomas, MD, and Andrea Natale, MD Doppler assessments of pulmonary venous (PV) and left atrial appendage flows are useful surrogates of left atrial (LA) function, but it is unknown if these can predict atrial fibrillation (AF) recurrence after pulmo- nary vein antrum isolation. We compared Doppler surrogates of LA function immediately after pulmo- nary vein antrum isolation in patients with AF recur- rence versus matched patients without recurrence. Patients with a 6-month recurrence had significantly lower LA appendage peak emptying velocity (19  10 vs 29  11 cm/s) and lower peak PV systolic wave velocity (36  17 vs 46  22 cm/s) compared with those without, suggesting that intracardiac Doppler assessment of LA function after AF ablation predicts AF recurrence. 2004 by Excerpta Medica, Inc. (Am J Cardiol 2004;94:951–954) D oppler assessments of pulmonary venous (PV) and left atrial appendage flows have been used as surrogates of left atrial (LA) reservoir and contractile function. 1–3 Previous studies have shown that the as- sessment of LA function by echocardiographic Dopp- ler can predict development of atrial fibrillation (AF), 4 success of cardioversion, 5 thromboembolic risk, 6 and long-term maintenance of sinus rhythm after tradi- tional electrical cardioversion. 7 Intracardiac echocar- diography is a useful tool that is commonly used for guidance of pulmonary vein antrum isolation and has been shown to correlate well with transesophageal echocardiography for LA function. 8 However, in the post-PV antrum isolation setting, it is unknown whether intracardiac echocardiographic assessment of LA function can predict AF recurrence. Thus, this study assesses whether intracardiac Doppler surro- gates of LA contractile function and compliance after From the Department of Cardiology, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, Cleveland, Ohio. Dr. Verma is supported by a fellowship award from the Heart and Stroke Foundation of Canada. Dr. Marrouche’s address is: Section of Car- diac Electrophysiology, Department of Cardiology, Cleveland Clinic Foundation, Desk F15, 9500 Euclid Avenue, Cleveland, Ohio 44195. E-mail: marroun@ccf.org. Manuscript received April 5, 2004; revised manuscript received and accepted June 8, 2004. 951 ©2004 by Excerpta Medica, Inc. All rights reserved. 0002-9149/04/$–see front matter The American Journal of Cardiology Vol. 94 October 1, 2004 doi:10.1016/j.amjcard.2004.06.039