What is the clinical evidence from this study?

Study design: Cohort. Population: Non-valvular atrial fibrillation (n=95). Intervention: Left atrial contractile strain (LASct). Primary outcome: Atrial fibrillation recurrence (OR 0.89, 95% CI 0.82-0.97, p=0.007).

November 5, 2022Open Access

Left atrial strain for predicting recurrence in patients with non-valvular atrial fibrillation after catheter ablation: a single-center two-dimensional speckle tracking retrospective study

Key Result

Left atrial contractile strain was an independent predictor of atrial fibrillation recurrence after catheter ablation (OR 0.89), with a value <8% identifying patients at higher risk.

Study Design

Type

Cohort (n=95)

Multicenter

Structured PICO

Does left atrial contractile strain (LASct) assessed by speckle tracking echocardiography predict atrial fibrillation recurrence in patients with non-valvular AF after catheter ablation?

Population

95 adults with non-valvular atrial fibrillation who underwent catheter ablation, followed for a median of 26.0 months.

Exposure

Pre-procedural assessment of left atrial contractile strain (LASct) using two-dimensional speckle tracking echocardiography (STE)

Outcome

Atrial fibrillation recurrence (caught by electrocardiogram, Holter electrocardiogram, or reappeared symptoms after a 3-month blanking period) at median 26.0 months follow-uphard clinical

Pre-procedural left atrial contractile strain (LASct) assessed by speckle tracking echocardiography is an independent predictor of atrial fibrillation recurrence after catheter ablation.

Main Result

Odds Ratio: 0.89 (95% CI 0.82–0.97)

p-value: p=0.007

Limitations

Retrospective single-center small design
Asymptomatic AF episodes or failure of capture by electrocardiogram may underestimate the recurrence rate
Two-year follow-up period may not be enough to capture all adverse events
Lack of additional information about laboratory indices and cardiac magnetic resonance data
Emphasis on LA function led to neglect of ablation details
Thin LA walls are not easy to track with speckle tracking echocardiography

Abstract

BACKGROUND: Although catheter ablation (CA) is an effective treatment for non-valvular atrial fibrillation (AF), a good many of patients still have a recurrence following post-operation. Prediction of AF recurrence by evaluating left atrial (LA) phase function with speckle tracking echocardiography (STE) may be helpful for risk stratification and clinical management for AF patients. Therefore, the current study aimed to assess the prognostic value of LA strains in non-valvular AF patients after CA. METHODS: A total of 95 non-valvular AF patients (70.5% paroxysmal AF, 56.8% males, mean age 63.2 ± 9.7 years) were included in this retrospective study between October 2019 and August 2020. Transthoracic echocardiography was performed in all the subjects and STE was used to analyze the LA reservoir strain (LASr), LA conduit strain (LAScd) and LA contractile strain (LASct) during different phases before CA. Patients were followed up with until January 2022. The endpoint was AF recurrence. RESULTS: Over a median follow-up period of 26.0 months (interquartile range, 24.7-26.7 months), 26 patients experienced recurrence and 69 stayed in sinus rhythm. Compared with no-recurrence group, maximum volume of LA (LAVmax), minimum volume of LA (LAVmin) and LA volume index (LAVI) were increased in the recurrence group, while LAEF, LASr and LASct were worsened (P < 0.05). Multivariable logistic regression analysis revealed that LASct was an independent predictor of AF recurrence (odds ratio, 0.89; 95% confidence interval (CI), 0.82-0.97; P = 0.007) and receiver operating characteristic (ROC) curve analysis showed an area under the curve of LASct<8% was 0.70 (95% CI, 0.59-0.79; P = 0.0008). CONCLUSIONS: LASct was of independent predictive value of AF recurrence. LA function assessed by STE may contribute to the risk stratification for AF patients and selection of suitable patients for CA.

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Cite This Study

Li et al. (Sat,) conducted a cohort in Non-valvular atrial fibrillation (n=95). Left atrial contractile strain (LASct) was evaluated on Atrial fibrillation recurrence (OR 0.89, 95% CI 0.82-0.97, p=0.007). Left atrial contractile strain was an independent predictor of atrial fibrillation recurrence after catheter ablation (OR 0.89), with a value <8% identifying patients at higher risk.

synapsesocial.com/papers/6a2981e1eff1696fc49ff7c1 https://doi.org/https://doi.org/10.1186/s12872-022-02916-y

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