Key result
In patients experiencing early recurrence of atrial fibrillation after totally thoracoscopic ablation, preoperative left atrial strain <18.6% was associated with an 83.0% risk of 5-year late recurrence, significantly higher than the 29.6% risk in patients without early recurrence (HR 4.83).
Why the study?
Data on predictors of late recurrence in patients who experience early AF events during the blanking period after AF ablation are limited.
Does preoperative left atrial strain predict late recurrence of atrial fibrillation in patients experiencing early recurrence after totally thoracoscopic ablation?
Cohort (n=128)
No
Does preoperative left atrial strain predict late recurrence of atrial fibrillation in patients experiencing early recurrence after totally thoracoscopic ablation?
Hazard Ratio: 4.83 (95% CI 2.75–8.48)
Absolute Event Rate: 83% vs 29.6%
p-value: p=<0.01
Preoperative left atrial strain is an independent predictor of long-term AF recurrence in patients who experience early recurrence after totally thoracoscopic ablation, providing a useful tool for risk stratification.
LA strain independently predicted late recurrence in early AF patients after TTA; hypothesis-generating for risk stratification, prospective validation required.
Background: Although early atrial fibrillation (AF) events during the blanking period after AF ablation are risk factors for late recurrence, data on predictors of late recurrence in patients who experience early AF events are limited. In this study, we investigated the implications of left atrial (LA) strain with respect to long-term outcomes in patients experiencing early AF during the blanking period after totally thoracoscopic ablation (TTA). Methods: A total of 128 patients who underwent TTA between 2012 and 2015 were enrolled from a tertiary center. Peak longitudinal LA strain was measured preoperatively. Early recurrence (ER) was defined as any AF within the 3-month blanking period after TTA. The primary outcome was late recurrence of AF for 5 years, detected on 12-lead electrocardiogram or 24-hour Holter monitoring, excluding the blanking period. Results: Out of 128 patients, 42 (32.8%) experienced ER during the blanking period. Patients who experienced ER had a significantly higher risk of 5-year AF recurrence compared with those who did not [72.7% vs. 29.6%, hazard ratio (HR) =3.69, 95% confidence interval (CI): 2.14−6.36, P<0.001]. Within the group of 42 patients experiencing ER, LA strain with a best cutoff value of 18.6% was the only independent predictor of 5-year AF recurrence (adjusted HR =4.20, 95% CI: 1.08−16.29, P=0.038). Patients with ER and LA strain ≥18.6% had a risk of 5-year AF recurrence, similar to those without ER (35.2% vs. 29.6%, HR =1.21, 95% CI: 0.36−4.04, P=0.755). Patients with ER and LA strain <18.6% had a significantly higher risk of 5-year AF recurrence compared to those without ER (83.0% vs. 29.6%, HR =4.83, 95% CI: 2.75−8.48, P<0.01). Conclusions: Early AF during the blanking period is common in patients undergoing TTA. In patients with ER, LA strain was an independent predictor of long-term AF recurrence.
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Kim et al. (2024) conducted a cohort in Atrial Fibrillation (n=128). Preoperative left atrial strain <18.6% in patients with early recurrence vs. Patients without early recurrence was evaluated on Late recurrence of atrial fibrillation at 5 years (HR 4.83, 95% CI 2.75-8.48, p=<0.01). In patients experiencing early recurrence of atrial fibrillation after totally thoracoscopic ablation, preoperative left atrial strain <18.6% was associated with an 83.0% risk of 5-year late recurrence, significantly higher than the 29.6% risk in patients without early recurrence (HR 4.83).
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