Left Atrial Stiffness: A Predictor of Atrial Fibrillation Recurrence after Radiofrequency Catheter Ablation - A Systematic Review and Meta-Analysis

Abstract

Background Radiofrequency catheter ablation (RFCA) is a standard procedure for patients with atrial fibrillation (AF) not responsive to previous treatments, that has been increasingly considered as a first-line therapy. In this context, perioperative screening for risk factors has become important. A previous study showed that a high left atrial (LA) pressure is associated with AF recurrence after ablation, which may be secondary to a stiff left atrium. Objective To investigate, through a systematic review and meta-analysis, if LA stiffness could be a predictor of AF recurrence after RFCA, and to discuss its clinical use. Methods The meta-analysis followed the MOOSE recommendations. The search was performed in MEDLINE and Cochrane Central Register of Controlled Trials databases, until March 2018. Two authors performed screening, data extraction and quality assessment of the studies. Results All studies were graded with good quality. A funnel plot was constructed, which did not show any publication bias. Four prospective observational studies were included in the systematic review and 3 of them in the meta-analysis. Statistical significance was defined at p value < 0.05. LA stiffness was a strong independent predictor of AF recurrence after RFCA (HR = 3.55, 95% CI 1.75-4.73, p = 0.0002). Conclusion A non-invasive assessment of LA stiffness prior to ablation can be used as a potential screening factor to select or to closely follow patients with higher risks of AF recurrence and development of the stiff LA syndrome.

Impaired left atrial stiffness in patients with corrected congenital left ventricular outflow obstructions

“…In a recent study, Reddy et al found that LA Stiff may be the best echocardiographic correlate of elevated filling pressures in patients with preserved LVEF 19 . Finally, abnormal LA Stiff values were associated with an increased incidence of cardiac events 8 and were a strong predictor of atrial fibrillation recurrence 20 . Combining E/Ea and LAS, LA Stiff is strongly influenced by LV properties 21 and is mainly modulated by LV longitudinal function through the downward motion of the mitral plane during ventricular systole.…”

Efficacy of LGE‐MRI‐guided fibrosis ablation versus conventional catheter ablation of atrial fibrillation: The DECAAF II trial: Study design

“…The multicenter observational study LGE‐MRI Determinant of Successful Radiofrequency Catheter Ablation of Atrial Fibrillation (DECAAF) 10 demonstrated that the extent of atrial fibrotic remodeling constitutes the strongest independent predictor of a successful treatment in patients undergoing ablation of AF. Various observational and systematic review studies have further confirmed the predictive value of LA fibrosis on AF ablation outcomes, 11,13‐15 highlighting the need to include atrial myopathy assessment in ablation selection criteria. Additionally, patients with lower residual fibrosis after ablation had less AF recurrence in observational studies, 16 suggesting a potential therapeutic benefit from substrate modification during ablation.…”

Left Atrial Pressure as a Predictor of Success in Catheter Ablation of Atrial Fibrillation in a Real-Life Cohort

“…Therefore, LA stiffness could be associated with LA histological changes and predicts sinus rhythm maintenance after treatment in AF patients. A systematic review and meta-analysis by Correia et al [ 13 ] found that LA stiffness could be a predictor of AF recurrence after catheter ablation. Indeed, left atrial pressure mirrors the extent of atrial stretch, which promotes both ectopic activity and reentry.…”