Post Procedural Peak Left Atrial Contraction Strain Predicts Recurrence of Arrhythmia after Catheter Ablation of Atrial Fibrillation

Abstract

Background Left atrial (LA) function can be impaired by the atrial fibrillation (AF) ablation and might be associated with the risk of recurrence. We sought to determine whether the post-procedural changes in LA function impact the risk of recurrence following AF ablation. Methods We retrospectively reviewed patients who underwent AF ablation between 2009 and 2011 and underwent transthoracic echocardiography before ablation, 1-day and 3-month after ablation. Peak left atrial contraction strain (PACS) and left atrial emptying fraction (LAEF) were evaluated during sinus rhythm and compared across the three time points. The primary endpoint was atrial tachyarrhythmia recurrence after ablation. Results A total of 144 patients were enrolled (mean age 61 ± 11 years, 77% male, 46% persistent AF). PACS and LAEF initially decreased 1-day following ablation but partially recovered within 3 months in PAF patients, with a similar trend in the PerAF patients. After median 24 months follow-up, 68 (47%) patients had recurrence. Patients with recurrence had higher PACS1-day than that in non-recurrence subjects (-10.9 ± 5.0% vs. -13.4 ± 4.7%, p = 0.003). PACS1-day -12% distinguished recurrence cases with a sensitivity of 67.7% and specificity of 60.5%. The Kaplan–Meier curves showed significant difference in 5-year cumulative probability of recurrence between those with PACS ≥ -12% and PACS < -12% (log rank p < 0.0001). Multivariate regression showed that PACS1-day was an independent risk factor of arrhythmia recurrence. Conclusions Left atrial function deteriorates immediately following AF ablation and partially recovers in 3 months but remains abnormal in the majority of patients. PACS1-day post procedure predicts arrhythmia recurrence at long-term follow-up.

Left Atrium Assessment by Speckle Tracking Echocardiography in Cryptogenic Stroke: Seeking Silent Atrial Fibrillation

“…Furthermore, the optimal cut-off points obtained to predict AF were determined by bootstrapping analysis: LAEF < 55%, PALs < 21.4%, and PACs < 12.9%. Similar results have been reported in other contexts, such as predicting recurrence of AF after catheter ablation [30]. Silent AF was diagnosed in 38% (20 of 53) of patients with normal LA size, and myocardial analysis detected the presence of LA dysfunction in 29 patients; of them, in 18 (62%), AF was detected, 14-paroxysmal, and 4-permanent (Figure 3).…”

Left Atrial Strain Helps Identifying the Cardioembolic Risk in Transient Ischemic Attacks Patients with Silent Paroxysmal Atrial Fibrillation

“…The strong association between reduced LA strains and AF has also been reported in other settings, such as predicting recurrence of AF after catheter ablation. 35 Pagola reported the presence of silent AF in 86% of cryptogenic stroke patients with normal LA size and decreased LA strain. 18 Bayes de Luna described a frequently under-recognized clinical condition characterized by advanced interatrial block, that is strongly associated with atrial fibrillation and that was identified as a risk factor for non-lacunar cardioembolic ischemic stroke and vascular dementia.…”

Speckle tracking echocardiography in early disease stages: a therapy modifier?

“…e56 Journal of Cardiovascular Medicine 2023, Vol 24 (suppl 1) Fig. 1 Arterial hypertension GLS >-16% predicts MACE in HHD [18] PALS <16% predicts DD [94] PALS is associated with VO2max and VE/VCO2 slope in uncomplicated T2DM [44] 80 mg/dL PALS <10% predicts AF recurrence after CA [85] GLS <-18.2% predicts outcome in AS [61] PALS <21% predicts events and functional capacity in MR [66] RV straon ≥-18% predicts 2-year mortality in functional TR [71] A GLS >-12% predicts scar at CMR and nonsustained tachicardia at follow-up [117] Relative reduction GLS >15% predicts LV dysfunction [110] Atrial fibrillation…”