Key result
Low left atrial reservoir strain linked to ~50% higher AF recurrence after cardioversion.
Why the study?
AF recurrence is common after electrical cardioversion for persistent AF, creating a need for clinically useful predictors such as left atrial reservoir strain.
Does left atrial reservoir strain assessed after electrical cardioversion predict atrial fibrillation recurrence at 4 weeks in adults with persistent atrial fibrillation?
Cohort (n=140)
Does left atrial reservoir strain assessed after electrical cardioversion predict atrial fibrillation recurrence at 4 weeks in adults with persistent atrial fibrillation?
Left atrial reservoir strain < 17% measured 3 to 6 hours after electrical cardioversion significantly predicts 4-week atrial fibrillation recurrence, identifying patients who may benefit from closer monitoring and management.
Left atrial reservoir strain <17% was associated with higher post-cardioversion AF recurrence risk; leaves open whether strain-guided monitoring improves outcomes.
Background Electrical cardioversion (ECV) for persistent atrial fibrillation (AF) is a method used to restore sinus rhythm (SR) to reduce symptoms and improve quality of life. However, AF recurrence is common, and there is a need for clinically useful predictors. Purpose We examined whether left atrial (LA) reservoir strain could predict AF recurrence 4 weeks after ECV for persistent AF. Methods We included 200 adults with persistent AF who were referred for ECV in an observational, cohort study. We performed transthoracic echocardiography using Automated Function Imaging to assess LA reservoir strain in participants with SR 3 to 6 hours after ECV for persistent AF. Participants recorded at-home ECGs twice daily and, if symptomatic, for 28 days after the ECV to detect AF recurrence. Results A total of 140 of 164 participants who underwent ECV for persistent AF were successfully cardioverted and had echocardiography assessable for LA strain. The mean age was 66.3 ± 8.8 years, and 80% were men. A total of 72 participants (51.4 %) had an AF recurrence during the observation period. LA reservoir strain was significantly lower in participants with AF recurrence than in those who maintained SR (13.5 % ± 4.4 vs. 15.7 % ± 5.7, p = 0.01). There was a non-linear association between LA reservoir strain and AF recurrence (p = 0.036). The area under the curve was 0.63 (95% CI 0.56-0.70) in a univariate receiver operating characteristic curve, and the optimal cutoff for LA reservoir strain was 17% (Youden index). A Kaplan-Meier plot showed a significant difference in time to AF recurrence between participants with LA reservoir strain < 17% and those with LA reservoir strain ≥ 17% (log-rank, p = 0.016). Participants with LA reservoir strain < 17 % had 50% higher hazard of AF recurrence compared to those with LA reservoir strain ≥ 17% (Hazard Ratio 1.5, 95% CI 1.04-2.04, p = 0.03). Conclusion LA reservoir strain was significantly lower in participants with AF recurrence than in those who maintained SR four weeks after ECV for persistent AF. LA reservoir strain < 17% was predictive of AF recurrence and suggests that additional follow-up and AF management may be needed.
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Andersen et al. (2026) conducted a cohort in Persistent atrial fibrillation (n=140). Left atrial reservoir strain <17% vs. Left atrial reservoir strain ≥17% was evaluated on Atrial fibrillation recurrence 4 weeks after electrical cardioversion (HR 1.5, 95% CI 1.04-2.04, p=0.03). Left atrial reservoir strain <17% predicted a 50% higher hazard of AF recurrence 4 weeks after electrical cardioversion compared to strain ≥17% (HR 1.5; 95% CI 1.04-2.04; p=0.03).
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