Key result
Compared with paroxysmal AF, patients with permanent AF had larger left atrial volumes (44.0 vs 36.9 ml/m2, p=0.025) and more impaired left atrial reservoir strain (15.5% vs 26.9%, p<0.001).
Why the study?
The choice between rate- and rhythm-control strategies in AF depends on anatomical and functional substrate, prompting investigation into bi-atrial characteristics and their therapeutic implications.
Observational
Patients with permanent AF exhibit larger atrial volumes and more impaired atrial strain compared to those with paroxysmal AF, suggesting that multimodality imaging of atrial substrate could help guide the choice between rate and rhythm control strategies.
Greater LA remodeling in permanent AF; hypothesis-generating for imaging to guide rate-rhythm decisions.
Atrial fibrillation (AF) remains the most common arrhythmia in clinical practice. The choice between a rate-control and rhythm-control strategy depends on various factors, including the anatomical and functional substrate. This study investigates the anatomical and functional characteristics of both atria in patients with AF and explores the potential therapeutic implications. From an ongoing registry of patients with paroxysmal or permanent AF, those who underwent cardiac computed tomography (CCT) were included. Left atrial (LA) and right atrial (RA) sizes were measured on CCT, whereas bi-atrial function was quantified with speckle tracking strain echocardiography. The mean LA volume index was 41.6 5.6 ml/m 2 , and the mean RA volume index was 71.0 21.6 ml/m 2 . Mean LA reservoir strain was 24.3 15.1%, compared with the mean RA reservoir strain of 21.6 13.2%. Patients with smaller LA volumes had higher LA reservoir strain values than those with larger LA volumes (24.6% [interquartile range (IQR) 15.8 to 35.8] vs 16.5% [IQR 11.2 to 25.0], p <0.001). Patients with permanent AF had larger LA volumes (44.0 [IQR 33.7 to 55.2] ml/m 2 vs 36.9 [IQR 30.1 to 47.1] ml/m 2 , p = 0.025) compared with paroxysmal AF. Patients with permanent AF had more impaired LA reservoir strain (15.5% [IQR 11.6 to 22.7] vs 26.9% [IQR 17.4 to 35.6], p <0.001) compared with paroxysmal AF. Similar trends were observed in the RA. In conclusion, atrial substrate characterization by CCT and speckle tracking strain echocardiography may have therapeutic implications, especially for choosing between a rate-control and rhythm-control strategy.
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Bax et al. (2022) conducted an observational in Paroxysmal or permanent Atrial Fibrillation. Permanent Atrial Fibrillation vs. Paroxysmal Atrial Fibrillation was evaluated on Left atrial reservoir strain (p=<0.001). Compared with paroxysmal AF, patients with permanent AF had larger left atrial volumes (44.0 vs 36.9 ml/m2, p=0.025) and more impaired left atrial reservoir strain (15.5% vs 26.9%, p<0.001).
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