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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.

Background Sleep disturbance caused by obstructive sleep apnea is recognized as a contributing factor to adverse cardiovascular outcomes. However, the effect of restless legs syndrome (RLS), another common cause of fragmented sleep, on cardiac structure, function and long-term outcomes is not known. We assessed the effect of frequent leg movement during sleep on cardiac structure and outcomes in patients with RLS. Methods In our retrospective study, RLS patients referred for polysomnography were divided into those with frequent (periodic movement index >35/hour) and infrequent (≤35/hour) leg movement during sleep. Long-term outcomes were determined using Kaplan-Meier and logistic regression models. Results Of 584 patients, 47% had periodic movement index >35/hour. Despite similarly preserved left ventricular ejection fraction, the group with periodic movement index >35/hour had significantly higher left ventricular mass and mass index reflective of left ventricular hypertrophy (LVH). There were no significant baseline differences in the proportion of patients with hypertension, diabetes, hyperlipidemia, prior myocardial infarction, stroke or heart failure or use of antihypertensive medications between the groups. Patients with frequent periodic movement index were older, predominantly male and had more prevalent coronary artery disease and atrial fibrillation. However, on multivariate analysis, periodic movement index >35/hour remained the strongest predictor for LVH (odds ratio 2.45, 95% confidence interval 1.67–3.59, P<0.001). Advanced age, female sex and apnea-hypopnea index were other predictors for LVH. Patients with periodic movement index >35/hour had significantly higher heart failure and mortality rates over 33-month median follow-up. Conclusions Frequent periodic leg movement during sleep is an independent predictor of severe LVH and associated with increased cardiovascular morbidity and mortality.

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