Impaired left atrial reservoir strain before electrical cardioversion independently predicted cardioversion failure and atrial fibrillation recurrence (pooled recurrence rate 35.2%).
Systematic Review (n=880)
Does echocardiographic assessment of left atrial reservoir strain (LASr) predict cardioversion failure and atrial fibrillation recurrence in patients undergoing electrical cardioversion?
Left atrial reservoir strain assessment before electrical cardioversion provides valuable prognostic information regarding the risk of cardioversion failure and subsequent atrial fibrillation recurrence.
Background: To date, only a few studies have evaluated left atrial (LA) mechanics in patients with atrial fibrillation (AF) scheduled for electrical cardioversion (ECV). The present systematic review has been primarily designed to summarize the main findings of these studies and to examine the overall effect of AF on left atrial reservoir strain (LASr) in patients undergoing ECV. Methods: All the echocardiographic studies evaluating the effect of AF on LA mechanics in patients scheduled for ECV, selected from the PubMed and EMBASE databases, were included. There was no limitation of time period. The risk of bias was assessed by using the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: The full texts of 12 studies with 880 AF patients were analyzed. The pooled ECV success rate was 91.5% (range 65.8–100%). Over a median follow-up of 5.4 months (range 0.3–12 months), 35.2% of the patients (range 5–68.8%) experienced AF recurrence. At baseline, the average LASr was 11.4% (range 6.2–17.7%). A reduced LASr before ECV was strongly correlated with reduced left atrial appendage (LAA) flow velocities and/or thrombosis. The main independent predictors of cardioversion failure were impaired LASr and previous AF history. A severe LASr deterioration was independently correlated with AF recurrence after ECV. The other independent predictors of AR relapses were LA asynchrony, reduced difference between post- and pre-ECV LASr, and reduced right atrial reservoir strain. Conclusions: LASr assessment before ECV may provide useful prognostic information about AF relapses and improve the refinement of the thromboembolic risk of AF patients scheduled for ECV.
Sonaglioni et al. (Tue,) conducted a systematic review in Atrial fibrillation (n=880). Left atrial reservoir strain (LASr) assessment was evaluated on Electrical cardioversion success rate and atrial fibrillation recurrence. Impaired left atrial reservoir strain before electrical cardioversion independently predicted cardioversion failure and atrial fibrillation recurrence (pooled recurrence rate 35.2%).