Incorporating pre-procedural peak atrial longitudinal strain (PALS) into a clinical model improved prediction of 12-month atrial arrhythmia recurrence after first catheter ablation for persistent AF, increasing C-index from 0.66 to 0.74 with HR 1.06 per 1% decrease in PALS (95% CI 1.03–1.10, p<0.001).
Prospective Cohort (n=410)
Outcome assessors blinded to PALS measurements
No
Does integrating pre-procedural peak atrial longitudinal strain (PALS) with clinical features improve the prediction of 12-month recurrence in patients undergoing first-time catheter ablation for persistent atrial fibrillation?
Pre-procedural peak atrial longitudinal strain (PALS) significantly improves the individualized prediction of 12-month recurrence after first-time catheter ablation for persistent atrial fibrillation compared to clinical features alone.
Estimación del efecto: HR 1.06 per 1% decrease in PALS (95% CI 1.03–1.10); C-index 0.74 for Clinical + PALS vs 0.66 Clinical-only; ΔAUC 0.08, p<0.001 (95% CI HR 1.06 (1.03–1.10))
valor p: p=<0.001
Background Recurrence after the first ablation for persistent atrial fibrillation (AF) is common. Existing clinical and structural prediction models have limited performance. Peak atrial longitudinal strain (PALS) quantifies left atrial function and may improve risk stratification. Objective To develop and validate a 12-month recurrence prediction model for persistent AF by integrating PALS with clinical features, and to evaluate its performance and clinical utility. Methods Single-center prospective cohort; of 629 patients screened, 429 were enrolled, and 410 were included in the final analysis after exclusions for image quality and loss during the blanking period. Pre-procedural PALS was measured with standardized quality control. The outcome was the first recurrence (30 s) between the end of the 90-day blanking period and 12 months. Cox models with restricted cubic splines assessed the dose–response. Model performance (C-index, time-dependent AUC, Brier score, calibration) was compared among “Clinical-only”, “Clinical + PALS”, and “Clinical + LAVI” models. Reclassification (NRI/IDI) and clinical net benefit (decision curve analysis) were evaluated, along with sensitivity and interaction analyses. Results PALS independently predicted recurrence (per 1% decrease: HR 1.06, 95% CI 1.03–1.10; p 0.001), with excellent reproducibility (ICC intraobserver 0.91–0.93, interobserver 0.87–0.91). Adding PALS to the Clinical-only model improved discrimination (C-index 0.74 vs. 0.66; ΔAUC 0.08, p 0.001) and calibration ( α = −0.02, β = 0.94). Reclassification improved (NRI 0.43; IDI 0.07; p 0.01). The Clinical + PALS model provided greater net benefit across thresholds of 10%–30% (max ΔNB 0.06 at 24%). The PALS effect was consistent across acquisition rhythms ( p -interaction = 0.417). Adding LAVI yielded more modest improvement (C-index 0.69; ΔAUC 0.03, p = 0.084). Conclusions Pre-procedural PALS significantly improves individualized prediction of 12-month recurrence after first ablation for persistent AF when combined with clinical features. The model shows robust performance and clinical net benefit, supporting PALS as a core functional metric in pre-procedural assessment.
Tu et al. (Mon,) conducted a prospective cohort in Adults aged 18–85 years with persistent atrial fibrillation scheduled for first-time left atrial catheter ablation (n=410). Peak atrial longitudinal strain (PALS) measurement incorporated into a clinical risk prediction model vs. Clinical-only prediction model (without PALS) and Clinical+LAVI (left atrial volume index) prediction model was evaluated on Recurrence of any atrial arrhythmia (AF, atrial flutter, or atrial tachycardia lasting ≥30s) occurring after the 90-day blanking period and within 12 months post-ablation (HR 1.06 per 1% decrease in PALS (95% CI 1.03–1.10); C-index 0.74 for Clinical + PALS vs 0.66 Clinical-only; ΔAUC 0.08, p<0.001, 95% CI HR 1.06 (1.03–1.10), p=<0.001). Incorporating pre-procedural peak atrial longitudinal strain (PALS) into a clinical model improved prediction of 12-month atrial arrhythmia recurrence after first catheter ablation for persistent AF, increasing C-index from 0.66 to 0.74 with HR 1.06 per 1% decrease in PALS (95% CI 1.03–1.10, p<0.001).