Left atrial structure and function predictors of recurrent fibrillation after catheter ablation: a systematic review and meta‐analysis

Abstract

Background Catheter ablation (CA) has become a conventional treatment for atrial fibrillation (AF), but remains with high recurrence rate. The aim of this metaanalysis was to determine left atrial (LA) structure and function indices that predict recurrence of AF. Methods We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, up to September 2017 in order to select clinical trials and observational studies which reported echocardiographic predictors of AF recurrence after CA. Eighty-five articles with a total of 16 126 patients were finally included. Results The pooled analysis showed that after a follow-up period of 21 AE 12 months, patients with AF recurrence had larger LA diameter with weighted mean difference (WMD: 2Á99 ([95% CI 2Á50-3Á47], P<0Á001), larger LA volume index (LAVI) maximal and LAVI minimal (P<0Á0001 for both), larger LA area (P<0Á0001), lower LA strain (P<0Á0001) and lower LA total emptying fraction (LA EF) (P<0Á0001) compared with those without AF recurrence. The most powerful LA predictors (in accuracy order) of AF recurrence were as follows: LA strain <19% (OR: 3Á1[95% CI, -1.3-10Á4], P<0Á0001), followed by LA diameter ≥50 mm (OR: 2Á75, [95% CI 1Á66-4Á56,] P<0Á0001), and LAVmax >150 ml (OR: 2Á25, [95% CI, 1.1-5Á6], P = 0Á0002). Conclusions Based on this meta-analysis results, a dilated left atrium with diameter more than 50 mm and volume above 150 ml or myocardial strain below 19% reflect an unstable LA that is unlikely to hold sinus rhythm after catheter ablation for atrial fibrillation.

Left atrial strain rate during atrial contraction predicts raised pulmonary capillary wedge pressure: evidence for left atrio-ventricular interaction

“…The cause for better relationship between LASRa and PCWP in post-capillary PH is probably due to the nonlinear relationship between LASRa and PCWP in the whole group. In adhering with previous studies and meta-analyses that reported LASs as the strongest predictor of cavity pressure and recurrent arrhythmia [26,27], the compromised LA strain rate during atrial contraction, we found, could be seen as directly reflecting LA myocardial dysfunction. This finding should indeed be considered in a fashion parallel to the left ventricle.…”

The prognostic significance of left atrial appendage peak flow velocity in the recurrence of persistent atrial fibrillation following first radiofrequency catheter ablation

“…The emptying of the diastolic LAA in AF was linked to and projected a good LA booster pump function (37). The LAA structure changes that precede LA remodeling, both in terms of operation and morphology, have been shown to predict AF recurrence (12,14). Based on the hemodynamic activity of the LAA and the findings of our work, we think that the LAA is a much more sensitive criterion for the prediction of AF recurrence than morphological remodeling or LA functional in the LA.…”

“…Certain variables, such as AF duration (8), body mass index (BMI) (9), high blood pressure (10), diabetes mellitus (11), left atrial (LA) diameter (12,13), LA strain (14), and other echocardiographic indexes (15,16) can play a role in predicting ablation outcomes. However, no valid parameter exists to forecast AF recurrence following ablation.…”

Speckle Tracking-Derived Left Atrial Stiffness Predicts Clinical Outcome in Heart Failure Patients with Reduced to Mid-Range Ejection Fraction

“…Limited increases in cavity size in diastole are associated with raised diastolic pressures which chronically result in the perpetual rise of LA pressures, increase in cavity volume and myocardial stretch [27,28]. These structural changes are bound to eventually compromise LA's intrinsic myocardial properties, reduce cavity deformation and increase its stiffness and fibrosis [28][29][30]. The end result of such abnormalities is the dilatation of mitral annulus, worsening mitral regurgitation, pulmonary venous hypertension and, later on, pulmonary arterial hypertension [31].…”