Left atrial strain predicts recurrence of atrial arrhythmias after catheter ablation of persistent atrial fibrillation

Abdul Shokor Parwani, Daniel-Armando Morris, Florian Blaschke, Martin Huemer, Burkert Pieske, Wilhelm Haverkamp, Leif-Hendrik Boldt, Abdul Shokor Parwani, Daniel-Armando Morris, Florian Blaschke, Martin Huemer, Burkert Pieske, Wilhelm Haverkamp, Leif-Hendrik Boldt

Abstract

Introduction: Success rates of catheter ablation (CA) of persistent atrial fibrillation (AF) are very variable. Identifying patients in whom sinus rhythm maintenance cannot be achieved after CA is a critical issue.

Methods: 2D speckle-tracking echocardiography was performed before the first CA procedure in consecutive patients with persistent AF. Left atrial (LA) strain was correlated with recurrence of atrial arrhythmias during the follow-up period of 15 months after one CA procedure with or without antiarrhythmic drugs (primary endpoint). In a secondary analysis, recurrences after two CA procedures were analysed.

Results: 102 patients were included. Patients with recurrence of atrial arrhythmias after one CA procedure (n=55) had significantly lower LA strain than those without recurrence (LA strain 9.7±2.4% vs 16.2±3.0%; p<0.001). Recurrence rate was significantly higher in patients with LA strain <10% than in those with LA strain between 10% and 14.5% and >14.5% (97.7%, 42.1% and 10.3%, respectively; p<0.001). In Cox regression analysis including age, comorbidities, left ventricular dysfunction and LA enlargement, low LA strain (<10%) was the strongest factor associated with recurrence of AF (HR 6.4 (2.4-16.9), p<0.001). Even after inclusion of a second CA procedure, LA strain <10% maintained a high predictive value for recurrence of atrial arrhythmias (86.4% (95% CI 73.3% to 93.6%)).

Conclusion: In patients with persistent AF, LA strain imaging could be very useful to select those patients who have a high risk of not benefiting from CA.

Keywords: atrial fibrillation; atrial fibrillation recurrence; catheter ablation; left atrial strain.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Myocardial Analysis of the Left Atrium Using 2D Speckle-Tracking Echocardiography. The fragmented white curve indicates the average of LA strain from all segments of the LA. Figure 1a corresponds to a patient with persistent AF with high risk for AF recurrence (i.e. LA strain

Figure 2

AF, atrial fibrillation; AUC, area…

Figure 2

AF, atrial fibrillation; AUC, area under the curve; Se, sensitivity; Sp, specificity.

Figure 2
AF, atrial fibrillation; AUC, area under the curve; Se, sensitivity; Sp, specificity.

Figure 3

AF, atrial fibrillation.

Figure 3

AF, atrial fibrillation.

Figure 3
AF, atrial fibrillation.
Figure 2
Figure 2
AF, atrial fibrillation; AUC, area under the curve; Se, sensitivity; Sp, specificity.
Figure 3
Figure 3
AF, atrial fibrillation.

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