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.

Association Between Left Atrial Stiffness Index and Atrial Fibrillation Recurrence in Patients Undergoing Left Atrial Ablation

“…19,20,[26][27][28] Our results are in accordance with a study by Morris et al 19 using LA strain pattern using echocardiographic measures, showing that AF ablation outcomes are correlated with the LA systolic and diastolic function. In another report, PV flow velocities measured by echocardiography were inversely associated with recurrence after CA in a relatively small study of 67 AF patients.…”

“…20 Another small study on 63 patients using speckled tracking on echocardiogram showed LA longitudinal strain as an independent predictor of recurrence after CA for AF. 26 A recent investigation by Motoki et al 27 showed 42% recurrence after initial AF ablation after a median of 8 months of follow-up in 256 In this study, LA diastolic function was estimated by constructing PV loops for a large sample of AF ablation patients who were followed prospectively. The method described in this study is labor-intensive and therefore would be difficult to implement in the clinical routine.…”

Echocardiographic predictors of atrial fibrillation recurrence after catheter ablation: A literature review

“…There are several studies indicating that LA strain has higher predictive value than LA size obtained from conventional echocardiography [31,32]. The LA strain reflects LA reservoir, conduit and booster pump function.…”

Evaluation of geometric, functional and mechanical parameters of left atrium remodeling after surgical treatment of isolated atrial fibrillation

“…В исследовании C. Hammerstingl et al указано, что сама ФП, по-видимому, уменьшает возможности деформации ЛП и снижение показателей пиковой продоль-ной деформации идентифицирует пациентов с высоким риском рецидива ФП после процедур аблации [10]. M. Mirza et al выявили, что замет-ное снижение продольной деформации лате-ральной стенки ЛП является независимым пре-диктором ФП после аблации (ОР 1,15, (1,02-1,28), p = 0,01) вне зависимости от расши-рения ЛП [11].…”