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Left atrial strain predicts atrial fibrillation recurrence in patients with persistent atrial fibrillation and preserved ejection fraction treated with catheter ablation

Background: Atrial fibrillation (AF) frequently recurs after radiofrequency catheter ablation (CA). This study investigated novel echocardiographic strain parameters as predictors of outcome in persistent AF patients treated with CA. Methods: 92 patients (mean age 62, mean CHA2DS2-VASc = 1.5) with persistent AF and preserved ejection fraction (EF) underwent first CA and echocardiography ≤ 30 days prior to CA. Left atrial (LA-GS) and left ventricular (LV-GS) global longitudinal strains were measured with 2D speckle tracking, and patients were followed for AF recurrence. Results: During follow-up of 13±3 months, 47 patients (51%) had AF recurrence. LA-GS (dichotomized to > or < 11.98 %) predicted freedom from AF recurrence (Figure 1). Patients with AF recurrence had lower LA-GS (11.3% vs 17.9% ; p<0.001), lower LV-GS (-12.3% vs -13.7% ; p=0.007), and greater LA volumes (40.7 vs 32.3 mL/m2 ; p=0.001). ROC analysis revealed that LA-GS predicted AF recurrence better than LV-GS (AUC= 0.89 vs. 0.67 ; p<0.001) or LAVI (AUC=0.89 vs. 0.71 ; p=0.007). LA-GS <11.98% had 77% sensitivity and 91% specificity for predicting AF recurrence. By multivariate analysis, when entered as binary variables LA-GS (<11.98%) (HR=5.50, 95% CI=2.74-11.06 ; p<0.001) and LAVI (>38 mL/m2) (HR=2.28, 95% CI=1.26-4.13 ; p=0.006) were independent predictors of AF recurrence. When echocardiographic parameters were entered as continuous variables LA-GS (HR=0.82, 95% CI=0.75-0.88 ; p<0.001) was the only independent predictor of AF recurrence. Conclusion: LA-GS using speckle tracking echocardiography is a strong and independent predictor of AF recurrence after first CA therapy in patients with persistent AF and preserved EF.

left atrial strain ; atrial fibrillation ; catheter ablation

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