Left atrial dyssynchrony time measured by tissue Doppler imaging to predict atrial fibrillation recurrences after pulmonary vein isolation

Abstract

Objective:In this study we assess the value of left atrial dyssynchrony time measured by tissue Doppler imaging (TDI) to predict recurrences after pulmonary vein isolation (PVI) in patients with paroxysmal and persistent atrial fibrillation (AF).Methods:One hundred sixty patients (57±7.5 years, 122 males) with symptomatic drug-refractory paroxysmal and persistent AF, undergoing PVI were enrolled in our study. PA peak time by tissue Doppler imaging (PApeak-TDI) is defined as the time measured from the start of P wave in lead II to the peak of A wave on the tissue Doppler tracing. Left atrial dyssynchrony was measured by subtracting the PApeak-TDI time measured at the mid-inter atrial septum from the PA peak-TDI time measured at the left atrial midlateral free wall, (LA dyssynchrony=PApeak TDI lateral-PApeak TDI septal).Results:During a mean follow-up of 12±3 months, recurrences occurred in 50 out of 160 patients. Patients with recurrence of atrial fibrillation had larger left atrial dyssynchrony time (26.5±2.4 ms vs. 23.5±2.3 ms, p<0.001). Left atrial dyssynchrony time of 25 ms has the best combined sensitivity and specificity (74% and 63% respectively) along with positive predictive value 53% and negative predictive value 85.5%. LA dyssynchrony time ≥25 ms was found to discriminate patients prone to AF recurrences over time. Multivariate regression analysis showed that left atrial dyssynchrony time (HR per ms: 1.69, p<0.001) was identified as independent predictor of AF recurrence.Conclusion:Left atrial dyssynchrony time is good clinical predictor of recurrence of AF after PVI in patients with paroxysmal and persistent AF.

Determinants of left intra‐atrial electromechanical delay as evaluated by tissue Doppler imaging in candidates for coronary artery bypass graft surgery

“…to be predictors of the occurrence or recurrence of AF, [9][10][11][12][13][14][15][16][17] some other investigators have regarded them as early markers of LA structural remodeling. [44][45][46][47] ] Nevertheless, a fact that was overlooked in their studies is that the LA functions as a pump, too, and similar to any other contractile pumps requires synchronized contractions to produce an optimal output.…”

“…The difference between ACTs at the septal and lateral walls of the left atrium (LA) is termed the “left intra‐atrial electromechanical delay” (LIAEMD), which is a better marker of AF perpetuation from a theoretical perspective and is slightly more complex to measure than are ACTs . LIAEMD is a marker of LA dyssynchrony in the inducibility of AF in electrophysiological study, in patients with paroxysmal supraventricular tachycardias, in patients with a history of AF, and in the recurrence of AF following pulmonary vein isolation …”

“…7 LIAEMD is a marker of LA dyssynchrony in the inducibility of AF in electrophysiological study, 14 in patients with paroxysmal supraventricular tachycardias, 15 in patients with a history of AF, 16 and in the recurrence of AF following pulmonary vein isolation. 17 Previously, the clinical and echocardiographic determinates of ACTs were investigated separately. 18 Still, a considerable proportion of the patients recruited in those investigations had a history of AF, whereas an insignificant proportion of their sample volumes had CAD.…”

Left atrial dyssynchrony time measured by tissue Doppler imaging to predict atrial fibrillation recurrences after pulmonary vein isolation:Is this a mirage or the panacea?

“…This study by Salah et al ( 15 ) provides a further and important step in the prediction of AF recurrence after PV isolation. Previously, Evranos et al ( 16 ) used LA electromechanical delay with a cut-off value of 29.5 ms as a predictor of AF recurrence after AF ablation.…”

“…Further, a LA dyssynchrony time of 25 ms had a positive predictive value of 53% and negative predictive value of 85.5% with the best combination of sensitivity and specificity (74% and 63%, respectively). Salah et al ( 15 ) also identified LA dyssynchrony time (HR per ms: 1.69, p<0.001) as an independent predictor of AF recurrence, and if it was ≥25 ms, then patients were prone to AF recurrences during follow-up. P wave duration (PWD) for whole patient group (n=160) was 109.4±15.6 ms; the no recurrence subgroup (n=110) had a shorter PWD (103.2±13.7 ms).…”