Total Atrial Conduction Time as a Predictor of Left Atrial Functional Recovery in Atrial Fibrillation

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial Fibrillation (n=109). Intervention: Longer preprocedural PA-TDI duration (≥144 ms) vs. Shorter preprocedural PA-TDI duration (<144 ms). Primary outcome: Left Atrial Reservoir Strain (LARS) at 6 months after catheter ablation (standardized beta -0.20, 95% CI -0.10 to -0.01, p=0.013).

Q: What does this research mean for the field?

Preprocedural PA-TDI duration is significantly and independently associated with left atrial functional recovery, measured by left atrial reservoir strain, at 6 months following catheter ablation in patients with atrial fibrillation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Hikari Seki; Koki Nakanishi; Masao Daimon; Kazutoshi Hirose; Kentaro Iwama; Yasuhiro Mukai; Yuriko Yoshida; Yuko Yamamoto; Megumi Hirokawa; Tomoko Nakao; Tsukasa Oshima; Takumi Matsubara; Yu Shimizu; Gaku Oguri; T. Kojima; Eriko Hasumi; Katsuhito Fujiu; Hiroyuki Morita; Makoto Kurano; Norihiko Takeda

doi:10.1016/j.jacadv.2025.102151

Figures

Graphical abstract published by JACC Advances — Graphical abstract · Published by JACC Advances · CC BY-NC-ND

Why the study?

Although catheter ablation promotes left atrial functional recovery in AF patients, the extent of recovery varies substantially, and whether preprocedural PA-TDI duration could predict this recovery was unknown.

Does preprocedural PA-TDI duration predict improvement of left atrial reservoir strain in patients with atrial fibrillation undergoing catheter ablation?

Study Design

Type

Cohort (n=109)

Multicenter

No

Structured PICO

Does preprocedural PA-TDI duration predict improvement of left atrial reservoir strain in patients with atrial fibrillation undergoing catheter ablation?

P

Population

109 patients with atrial fibrillation in sinus rhythm undergoing their first catheter ablation, mean age 64, followed for a median of 465 days.

E

Exposure

Preprocedural measurement of PA-TDI duration (time delay between P-wave on electrocardiogram and peak A'-wave on tissue-Doppler imaging) prior to catheter ablation.

O

Outcome

Left atrial reservoir strain (LARS) at 6 months after catheter ablation evaluated by speckle-tracking echocardiographysurrogate

Main Result

Effect estimate: standardized beta -0.20 (95% CI -0.10 to -0.01)

Absolute Event Rate: 30.4% vs 33.8%

p-value: p=0.013

Echocardiographic measurement of preprocedural PA-TDI duration can independently predict left atrial functional recovery at 6 months following catheter ablation in patients with atrial fibrillation.

Limitations

Only included AF patients in sinus rhythm at the time of preprocedural echocardiography, limiting applicability to other AF populations
Short follow-up period of 6 months for assessing durable LA functional recovery and clinical outcomes
Follow-up echocardiography missing in 7.3% of patients, potentially introducing selection bias
Included only AF patients with sinus rhythm at the time of preprocedural echocardiography, limiting applicability to patients with long-standing AF.
The 6-month follow-up period is relatively short for assessing durable LA functional recovery and clinical outcomes such as AF recurrence or heart failure hospitalization.
Follow-up echocardiography with speckle-tracking analysis was not completed in 8 (7.3%) patients, which may introduce selection bias.

Implication

PA-TDI may flag limited LA recovery post-ablation; hypothesis-generating for risk stratification, requiring prospective validation before clinical use.

Abstract

BACKGROUND: Catheter ablation (CA) leads to the recovery of left atrial (LA) function in patients with atrial fibrillation (AF), although the degree varies substantially among individuals. PA-TDI duration, the time delay between the P-wave on the electrocardiogram to the peak A'-wave on tissue-Doppler imaging of the lateral LA wall is an echocardiographic measure that reflects structural and electrical LA remodeling. OBJECTIVES: The objective of the study was to investigate whether the preprocedural PA-TDI duration could predict LA functional recovery after CA. METHODS: We studied 109 AF patients in sinus rhythm at preprocedural echocardiography, who underwent their first CA. PA-TDI duration was measured by tissue Doppler imaging from the apical four-chamber view. Speckle-tracking echocardiography was performed before and 6 months after CA to evaluate LA reservoir strain (LARS). RESULTS: The median (25th-75th percentile) PA-TDI duration was 144 (128-162) ms. There was no significant difference in age, sex, and AF risk factors between patients with longer PA-TDI duration (≥144 ms) and those with shorter PA-TDI duration (<144 ms). The median follow-up was 465 (273-746) days. LARS was significantly improved at 6 months after CA (29.7% ± 7.9% to 32.1% ± 6.7%; P < 0.001). Preprocedural PA-TDI duration was significantly associated with LARS at 6 months after CA independent of AF type, baseline LARS, and recurrent AF (standardized beta -0.20; 95% CI: -0.10 to -0.01; P = 0.013). Combination of baseline LARS and PA-TDI duration provided enhanced predictive value for postprocedural LA function (P < 0.001). CONCLUSIONS: The measurement of PA-TDI duration provided valuable information for LA functional recovery in AF patients who underwent CA.

Discussion

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Cite This Study

Seki et al. (2025) conducted a cohort in Atrial Fibrillation (n=109). Longer preprocedural PA-TDI duration (≥144 ms) vs. Shorter preprocedural PA-TDI duration (<144 ms) was evaluated on Left Atrial Reservoir Strain (LARS) at 6 months after catheter ablation (standardized beta -0.20, 95% CI -0.10 to -0.01, p=0.013).

synapsesocial.com/papers/6a1571dfcb0379474a823d73 https://doi.org/10.1016/j.jacadv.2025.102151