Impaired left atrial reservoir strain (< 23%) was independently associated with an increased risk of flecainide discontinuation due to rhythm control failure (HR 9.09) in patients with atrial fibrillation.
Cohort (n=70)
Yes
Does left atrial strain predict flecainide discontinuation due to rhythm control failure better than left atrial volume index in patients with atrial fibrillation?
Impaired left atrial strain is independently associated with rhythm control failure in AF patients on long-term flecainide, offering better predictive sensitivity than left atrial volume index.
Effect estimate: HR 9.09 (95% CI 2.34-35.3)
p-value: p=0.001
Left atrial volume index (LAVI) is associated with recurrent atrial fibrillation (AF) during flecainide treatment. Nevertheless, AF patients with normal LAVI experience rhythm control failure. Our study sought to compare the association between left atrial strain and LAVI with rhythm control failure, in flecainide treated patients with AF. This retrospective cohort study included consecutive patients ≥ 18 years of age with AF who were discharged after in-hospital initiation of flecainide. Patients without an echocardiogram in sinus rhythm within one year of initiation of flecainide were excluded. The primary endpoint was discontinuations due to rhythm control failure. Receiver operating characteristics determined optimal cutoffs for reservoir (LASr), conduit (LAScd) and contractile (LASct) left atrial longitudinal strains for the primary endpoint. These cutoffs were analysed using Cox regression, with 95% confidence intervals. Seventy patients were followed for a mean of 1.71 ± 1.56 years (mean age 59.4 ± 11.5 years; 66% male; 8.6% had persistent AF). The area under the curve for LASr was 0.764 (0.595–0.933), for LAScd 0.784 (0.634–0.934), and for LAVI 0.497 (0.345–0.795). Optimal cutoffs for LASr were < 23% and LAScd < 14.5%. These cutoffs had similar specificity (LASr 85% and LAScd 73%) but higher sensitivity (70% and 90%, respectively) compared to ≥moderately increased LAVI (84% and 36%) for the primary endpoint. Hazard ratios for LASr < 23% and LAScd < 14.5% were 9.09 (2.34–35.3) and 18.3 (2.31–145), respectively. Impaired left atrial strain was associated, independently from LAVI, with discontinuations due to rhythm control failure in patients receiving long-term flecainide treatment for AF.
Siotis et al. (Tue,) conducted a cohort in Atrial fibrillation (n=70). Left atrial reservoir strain (LASr) < 23% vs. LASr ≥ 23% was evaluated on Flecainide discontinuation due to clinically assessed rhythm control failure (HR 9.09, 95% CI 2.34-35.3, p=0.001). Impaired left atrial reservoir strain (< 23%) was independently associated with an increased risk of flecainide discontinuation due to rhythm control failure (HR 9.09) in patients with atrial fibrillation.