Left Atrial Reservoir Function Predicts Atrial Fibrillation Recurrence After Catheter Ablation: A Two-Dimensional Speckle Strain Study

Abstract

Background-Predictors of atrial fibrillation (AF) recurrence after catheter ablation (CA) are not fully defined. We hypothesized that 2D left atrial (LA) regional strain maps would help identify abnormal atrial substrate that increases susceptibility to AF recurrence post-CA. Methods and Results-Sixty-three patients (63±10 years, 60% male) underwent CA for symptomatic paroxysmal (75%) or persistent (25%) AF. Baseline LA mechanical function determined using speckle tracking echocardiography was compared between those with AF recurrence (AFR) and no recurrence post-CA. Bi-dimensional global and regional maps of LA wall velocity, strain, and strain rate (SR) were obtained during end ejection and early diastole. After 18±12 months of follow-up, 34 patients were free of AFR post-CA. There were no differences in clinical characteristics, LA and LV volumes, and Doppler estimates of LV diastolic function and filling pressures at baseline between patients with recurrent AF and those that maintained sinus rhythm. However, the LA emptying fraction (55±17% vs. 64±14%, p=0.04), global and regional systolic and diastolic strains, SR, and velocities were reduced in patients with recurrent AF. There was marked attenuation of peak LA lateral wall longitudinal strain (LS; 11±7% vs. 20±14%, p=0.007) and SR (0.9±0.4 vs. 1.3±0.6 s −1 , p=0.01). Multivariate analysis revealed lateral wall LS (odds ratio=1.15, 95% CI=1.02-1.28, p=0.01) as an independent predictor of AFR. Conclusions-Regional LA lateral wall LS is a pre-procedural determinant of AFR in patients undergoing CA, independent of LA enlargement. Characterization of atrial myocardial tissue properties by speckle tracking echo may aid the appropriate selection of adjunctive strategies and prognostication of patients undergoing CA.

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

“…383,384 New echocardiographic techniques-Two-dimensional speckle-tracking echo has been used as a more sensitive marker to detect early functional remodelling before anatomical alterations occur. [385][386][387][388][389][390][391][392][393][394][395][396][397][398][399][400] Strain (S) and strain rate (SR) imaging provide data on myocardial deformation by estimating spatial gradients in myocardial velocities. 385,388,392,393,[401][402][403][404][405] This technique has been used as a surrogate of LA structural remodelling and fibrosis.…”

“…388,389,[396][397][398][399][400] Population-based studies have demonstrated the prognostic value of LA strain analysis for long-term outcome. 388,394 Less research and fewer clinical outcomes data are available on the quantification of RA size. Right atrial volumes are also underestimated with 2D echocardiographic techniques compared with 3DE.…”

The Difference of Predictors for Recurrence After Catheter Ablation of Non-Paroxysmal Atrial Fibrillation According to Follow-Up Period

“…22) Recently, several study groups attempted to clarify the value of LA function to predict AF recurrence using LA deformation imaging in patients undergoing either cardioversion 23,24) or ablation procedures. 8,9,25) In some previous studies, deteriorated LA global strain was suggested to be a risk factor for AF recurrence after ablation. 9,26) LAeF was used in our study and it is a generally accepted representative of LA reservoir function, similar to LA global strain.…”

Tissue Velocity Imaging-Based Atrial Fibrillatory Cycle Length and Wall Motion for Predicting Atrial Structural Remodeling in Patients Undergoing Catheter Ablation

“…2,11-13 With regard to the association between atrial mechanical function and atrial remodeling, atrial mechanical function during sinus rhythm assessed by speckle tracking echocardiography has been shown to be an independent predictor of recurrence of AF or LA reverse remodeling after ablation. 22, 23 Theoretically, the reduced atrial contraction during AF rhythm shown by AFW-V-tvi would predispose to the reduced atrial mechanical function during sinus rhythm. In the present study, AFW-V-tvi correlated well with septal a' velocity during sinus rhythm 1 day after ablation.…”