Left atrial strain is a powerful predictor of atrial fibrillation recurrence after catheter ablation: study of a heterogeneous population with sinus rhythm or atrial fibrillation

Yasuda, Risako; Murata, Mitsushige; Roberts, Rachel; Tokuda, Hanako; Minakata, Yugo; Suzuki, Keiko; Tsuruta, Hikaru; Kimura, Tokuhiro; Nishiyama, Nobuhiro; Fukumoto, Kotaro; Aizawa, Yoshifusa; Tanimoto, Kojiro; Takatsuki, Seiji; Abe, Takayuki; Fukuda, Keiichi

doi:10.1093/ehjci/jev028

Cited by 66 publications

(61 citation statements)

References 17 publications

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“…[ 132 ] Patients with lower LA total strain and global strain were found to have a higher recurrence of AF after ablation (OR 0.81; 95% CI [0.73– 0.89]; p<0.0001). [ 133 ]…”

Section: Clinical Evaluation Of Myopathymentioning

confidence: 99%

Atrial Myopathy Underlying Atrial Fibrillation

Rivner

Mitrani

Goldberger

2020

Arrhythmia &Amp; Electrophysiology Review

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While AF most often occurs in the setting of atrial disease, current assessment and treatment of patients with AF does not focus on the extent of the atrial myopathy that serves as the substrate for this arrhythmia. Atrial myopathy, in particular atrial fibrosis, may initiate a vicious cycle in which atrial myopathy leads to AF, which in turn leads to a worsening myopathy. Various techniques, including ECG, plasma biomarkers, electroanatomical voltage mapping, echocardiography, and cardiac MRI, can help to identify and quantify aspects of the atrial myopathy. Current therapies, such as catheter ablation, do not directly address the underlying atrial myopathy. There is emerging research showing that by targeting this myopathy we can help decrease the occurrence and burden of AF.

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“…[ 132 ] Patients with lower LA total strain and global strain were found to have a higher recurrence of AF after ablation (OR 0.81; 95% CI [0.73– 0.89]; p<0.0001). [ 133 ]…”

Section: Clinical Evaluation Of Myopathymentioning

confidence: 99%

Atrial Myopathy Underlying Atrial Fibrillation

Rivner

Mitrani

Goldberger

2020

Arrhythmia &Amp; Electrophysiology Review

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“…However, no patients with MRFs had been reported to have AF during hospitalization, to have intracardiac thrombus, or to ever be anticoagulated. Other variables that might have related to AF were not available, such as the right-sided AEMD or a novel index of LA strain [26]. Finally, influence of anti-arrhythmic drugs on AEMD remains to be evaluated.…”

Section: Limitationsmentioning

confidence: 99%

Usefulness of tissue Doppler-derived atrial electromechanical delay for identifying patients with paroxysmal atrial fibrillation

Akamatsu

Ito

Miyamura

et al. 2020

Cardiovasc Ultrasound

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Background: Tissue Doppler imaging (TDI)-derived atrial electromechanical delay (AEMD) has been reported to be useful for detecting paroxysmal atrial fibrillation (PAF). However, its usefulness remains unknown when analyzed along with patients seemingly at high-risk for AF as controls. From this standpoint, we investigated whether AEMD would be of use for identifying patients with PAF. Methods: We retrospectively analyzed TDI recordings to obtain AEMD in 63 PAF patients. Thirty-three patients with multiple cardiovascular risk factors (MRFs) but without history of AF and 50 healthy individuals served as disease and healthy controls, respectively. AEMD was defined as the time-interval between the electrocardiogram P-wave and the beginning of the spectral TDI-derived A' for the septal (septal EMD) and lateral (lateral EMD) sides of the mitral annulus. Results: There was no significant difference in the left atrial volume index between PAF patients and disease controls (28 ± 9 mL/m 2 vs. 27 ± 5 mL/m 2). PAF patients had longer AEMD, particularly for the lateral EMD (75 ± 23 ms), compared with disease (62 ± 22 ms, P = 0.009) and healthy (54 ± 24 ms, P < 0.001) controls. Multivariate logistic regression analysis revealed that the lateral EMD (OR 1.25, 95%CI 1.03-1.52, P = 0.023), along with the left atrial volume index (OR 2.25, 95%CI 1.44-3.51, P < 0.001), was one of the significant independent associates of identifying PAF patients. Conclusions: This cross-sectional study indicates that even analyzed together with MRFs patients, AEMD remains useful for identifying patients at risk for AF. Our results need to be confirmed by a large-scale prospective study.

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“… 16) Usefulness of the LALS is evidenced by several previous studies demonstrating that LA strain well predicts not only AF recurrence after radiofrequency ablation, but also reverse remodeling of LA. 4) 34) 35) 36) Overall, our results suggest that global LALS provide additive predictive value to clinical risk predicting tool, CHA 2 DS 2 -VASc score for predicting post stroke AF in acute ischemic stroke patients.…”

Section: Discussionmentioning

confidence: 62%

Incremental Value of Left Atrial Global Longitudinal Strain for Prediction of Post Stroke Atrial Fibrillation in Patients with Acute Ischemic Stroke

Kim

Shim

Cho

et al. 2016

J Cardiovasc Ultrasound

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BackgroundAtrial fibrillation (AF) is a well-established risk factor for stroke. Interestingly, ischemic stroke increases risk of incident AF in patients without prior diagnosed AF. For better risk stratification for post-stroke AF, we studied left atrial (LA) size and mechanical function using two-dimensional (2D) speckle tracking imaging in patients with acute ischemic stroke.MethodsA total of 227 patients (132 males, age 67 ± 12) with acute ischemic stroke without a history of AF underwent 2D transthoracic echocardiography and speckle tracking imaging for the assessment of LA volume index and global LA longitudinal strain (LALS). From clinical variables, the CHA2DS2-VASc score and National Institute of Health Stroke Scale (NIHSS) were calculated in each patient. Post-stroke AF was defined as newly diagnosed AF during the course after ischemic stroke.ResultsPost-stroke AF occurred in 25 patients (11%). Patients with post-stroke AF were older and showed a higher tendency of CHA2DS2-VASc score, significantly higher log NIHSS, larger LA volume index and lower global LALS than those without. In multivariate analysis, global LALS was an independent predictor for post-stroke AF (hazard ratio 0.90, 95% confidence interval 0.83.0.97, p < 0.01) after controlling for confounding factors. Furthermore, global LALS provided incremental predictive value for post-stroke AF over the CHA2DS2-VASc score, NIHSS, and LA volume index. The global LALS < 14.5% better distinguished post-stroke AF (area under the curve 0.837, sensitivity 60%, specificity 95%, p < 0.01) than CHA2DS2-VASc score.ConclusionGlobal LALS as a marker of LA mechanical function has incremental predictive value for post-stroke AF in patients with acute ischemic stroke.

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Left atrial strain is a powerful predictor of atrial fibrillation recurrence after catheter ablation: study of a heterogeneous population with sinus rhythm or atrial fibrillation

Abstract: LA myocardial function assessed by basal LA-LS could predict AF recurrence after CA. Notably, such an assessment could be applicable even during AF rhythm, suggesting its convenience in the clinical setting without defibrillation before analysis.

Cited by 66 publications

References 17 publications

Atrial Myopathy Underlying Atrial Fibrillation

Atrial Myopathy Underlying Atrial Fibrillation

Usefulness of tissue Doppler-derived atrial electromechanical delay for identifying patients with paroxysmal atrial fibrillation

Incremental Value of Left Atrial Global Longitudinal Strain for Prediction of Post Stroke Atrial Fibrillation in Patients with Acute Ischemic Stroke

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