Incremental value of left atrial strain to predict atrial fibrillation recurrence after cryoballoon ablation

Abstract

Objective Atrial fibrillation (AF) recurrence occurs in approximately 25% of the patients undergoing cryoballoon ablation (CBA), leading to repeated ablations and complications. Left atrial (LA) dilation has been proposed as a predictor of AF recurrence. However, LA strain is a surrogate marker of LA mechanical dysfunction, which might appear before the enlargement of the LA. The purpose of this study was to evaluate the additional predictive value of LA function assessed using strain echocardiography for AF recurrence after CBA. Methods 172 consecutive patients (62.2 ± 12.2 years, 61% male) were prospectively analyzed. Echocardiography was performed before CBA. Blanking period was defined as the first three months post-ablation. The primary endpoint was AF recurrence after the blanking period. Results 50 (29%) patients had AF recurrence. In the overall study population, peak atrial longitudinal strain (PALS) ≤ 17% had the highest incremental predictive value for AF recurrence (HR = 9.45, 95%CI: 3.17–28.13, p < 0.001). In patients with non-dilated LA, PALS≤17% remained an independent predictor of AF recurrence (HR = 5.39, 95%CI: 1.66–17.52, p = 0.005). Conclusions This study showed that LA function assessed by PALS provided an additional predictive value for AF recurrence after CBA, over LA enlargement. In patients with non—dilated LA, PALS also predicted AF recurrence. These findings emphasize the added value of LA strain, suggesting that it should be implemented in the systematic evaluation of AF patients before CBA.

Left atrial functions in the early period after cryoballoon ablation for paroxysmal atrial fibrillation

“…20 In a previous study which is performed using 2D-STE method and includes the patients with persistent and paroxysmal AF, peak atrial longitudinal strain parameter which is measured before the procedure has been shown to be effective in predicting the AF recurrences occurring 3 months after the procedure in both patients with LA size in normal ranges and patients with an enlarged LA. 21 The results of our study detected no significant change in the parameters of diastolic functions. Despite the non-significant increase in the left atrial dimension, a significant improvement was detected in the parameters, LAsr and LAsct which shows the ability of compliance and contractility of the LA through the 2D-STE method.…”

“…LA strain and strain rate imaging using tracking of acoustic kernels by 2D‐STE, a novel angle‐independent tool for measuring myocardial stretch with the ability to quantitatively analyze global and regional LA contractility and relaxation, could therefore serve as a noninvasive tool to identify contractile dysfunction while overcoming the existing limitations of Doppler‐based technologies 20 . In a previous study which is performed using 2D‐STE method and includes the patients with persistent and paroxysmal AF, peak atrial longitudinal strain parameter which is measured before the procedure has been shown to be effective in predicting the AF recurrences occurring 3 months after the procedure in both patients with LA size in normal ranges and patients with an enlarged LA 21 . The results of our study detected no significant change in the parameters of diastolic functions.…”

Left Atrial Functions in the Early Period after Cryoballoon Ablation for Paroxysmal Atrial Fibrillation

“…LA strain and strain rate imaging using tracking of acoustic kernels by 2D-STE, a novel angle-independent tool for measuring myocardial stretch with the ability to quantitatively analyze global and regional LA contractility and relaxation, could therefore serve as a noninvasive tool to identify contractile dysfunction while overcoming the existing limitations of Doppler-based technologies [19]. In a previous study which is performed using 2D-STE method and includes the patients with persistent and paroxysmal AF, peak atrial longitudinal strain parameter which is measured before the procedure has been shown to be effective in predicting the AF recurrences occurring 3 months after the procedure in both patients with LA size in normal ranges and patients with an enlarged LA [20]. The results of our study detected no signi cant change in the parameters of diastolic functions.…”

Nomogram to predict recurrence risk factors in patients with non‐valvular paroxysmal atrial fibrillation after catheter radiofrequency ablation

“…The community of patients with AF recurrence is varied in terms of age, gender, structural heart disease, comorbidities such as hypertension and diabetes, history of congestive heart failure and embolic events, and type of AF, according to studies conducted over the years. 5,6 For instance, atrial fibrosis measured by LGE-CMR is associated with the probability of recurrence after cryoball ablation. 7,8 The study of left atrial appendage blood flow velocity as an independent risk factor for recurrence of AF by transesophageal echocardiography.…”

“…Patients with a higher risk of postoperative recurrence can be identified through preoperative examination, thus improving the success rate and minimizing the dangers of the surgery. The community of patients with AF recurrence is varied in terms of age, gender, structural heart disease, comorbidities such as hypertension and diabetes, history of congestive heart failure and embolic events, and type of AF, according to studies conducted over the years 5,6 . For instance, atrial fibrosis measured by LGE‐CMR is associated with the probability of recurrence after cryoball ablation 7,8 .…”