The usefulness of global left atrial strain for predicting atrial fibrillation recurrence after catheter ablation in patients with persistent and paroxysmal atrial fibrillation

Abstract

Background: Given the potential complications of atrial fibrillation (AF) recurrence after ablation, better predictors of the effectiveness of the procedure are necessary to guide patient selection.

Aim: This prospective study was conducted to evaluate the clinical relevance of global left atrial longitudinal strain (GLAS) and AF recurrence after catheter ablation.

Methods: In 115 consecutive patients with AF (persistent, n=62; paroxysmal, n=53), transthoracic echocardiography was performed before catheter ablation to assess baseline left atrial mechanical function using speckle tracking echocardiography (STE).

Results: After 12 months of follow-up, 22 (35.5%) patients in the persistent AF group and 15 (28.3%) in the paroxysmal AF group exhibited AF recurrence. In both the paroxysmal and persistent AF populations, patients with recurrence presented with significantly impaired GLAS compared with patients without recurrence. Patients with recurrence also had a significantly higher pro-B-type natriuretic peptide concentration. A receiver operator curve analysis yielded area under the curve values of 0.94 and 0.86 for paroxysmal and persistent AF, respectively. In a multivariable Cox proportional-hazards analysis, GLAS was an independent predictor of AF recurrence after catheter ablation in both the paroxysmal AF group (hazard ratio: 0.79, 95% confidence interval: 0.67-0.96; P=0.01) and the persistent AF group (hazard ratio: 0.81, 95% confidence interval: 0.71-0.93; P=0.004).

Conclusions: In both paroxysmal and persistent AF, decreased baseline left atrial deformation capabilities assessed by two-dimensional STE can help to identify patients at high risk of AF recurrence after catheter ablation. This variable may help to guide candidate selection and improve therapeutic strategies.

Keywords: Ablation par cathéter; Atrial fibrillation; Atrial function; Catheter ablation; Fibrillation atriale; Fonction auriculaire gauche; LA strain; Strain auriculaire gauche.