Key result
Reservoir LA strain independently predicted 3-month AF recurrence (OR 0.97; P=0.001), whereas RA-LV coupling index predicted 12-month recurrence (OR 4.33, 95% CI 1.68-11.17; P=0.002).
Why the study?
Left atrial functional and geometric alterations before ablation are associated with AF recurrence, whereas right atrial parameters and their predictive value relative to left atrial parameters have been less characterized.
Do right and left atrial strain and geometric parameters measured by transthoracic echocardiography predict 3-month and 12-month recurrence of atrial fibrillation in patients with paroxysmal atrial fibrillation undergoing catheter ablation?
Observational (n=676)
No
Do right and left atrial strain and geometric parameters measured by transthoracic echocardiography predict 3-month and 12-month recurrence of atrial fibrillation in patients with paroxysmal atrial fibrillation undergoing catheter ablation?
In paroxysmal AF patients undergoing ablation, baseline reservoir left atrial strain independently predicts early (3-month) AF recurrence, whereas right atrial-to-left ventricular volumetric coupling independently predicts long-term (12-month) recurrence, highlighting the role of bi-atrial remodeling in long-term ablation efficacy.
May refine post-ablation recurrence risk stratification; hypothesis-generating and requires prospective validation before clinical adoption.
Background Left atrial functional and geometric alteration before ablation procedures has long been associated with recurrence of atrial fibrillation (AF). Right atrial parameters have been less characterized. Purpose To explore the potential difference in value between right and left atrial strain and geometric parameters in the prediction of ablation outcomes for paroxysmal AF. Methods Paroxysmal AF patients receiving catheter ablation (radiofrequency or cryoballoon) for pulmonary vein isolation between 2014 and 2024 and followed up in a tertiary center were retrospectively reviewed. All participants underwent transthoracic echocardiography before the index ablation, and off-line two-dimensional speckle-tracking analysis was collected. Multivariate Logistic regression analysis was used to identify right and left atrial strain and geometric parameters in the prediction of 3-month and 12-month recurrence of AF. Results A total of 676 patients with paroxysmal AF who underwent ablation and completed 3-month and 12-month follow-up were analyzed, among whom 230 (34.0%) were females, and the average age was 62±10 years. Early (3-month) and long-term (12-month) relapses were observed in 255 (37.7%) and 210 (31.1%) cases, respectively. Left atrial end-systolic volume (LAESV) and left atrial ejection fraction (LAEF), reservoir left atrial strain (LA-Sr), and right atrial strain (RA-Sr) were associated with short-term (3-month) AF recurrence, while LA-Sr was an independent predictor of 3-month AF recurrence [OR(95%CI): 0.97(0.96-0.99)，p=0.001]. Right atrial end-diastolic volume (RAEDV), RA-Sr, as well as LAESV, LAV coupling index [left atrial end-diastolic volume (LAEDV)/ left ventricular end-diastolic volume (LVEDV)], and RA-LV coupling index (RAEDV/LVEDV) were associated with long-term (12-month) AF recurrence. RA-LV coupling index was an independent predictor of 12-month AF recurrence [OR(95%CI): 4.33(1.68-11.17) ，p=0.002]. Conclusions Early recurrence of AF after ablation showed a closer relationship to LA dysfunction. In contrast, more significant RA enlargement and functional deterioration suggest advanced bi-atrial remodeling and provide additional value in the prediction of long-term efficacy of AF ablation.
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Chu et al. (2026) conducted an observational in Paroxysmal atrial fibrillation (n=676). Right and left atrial strain and geometric parameters (specifically RA-LV coupling index and reservoir LA strain) was evaluated on 12-month recurrence of atrial fibrillation (OR 4.33, 95% CI 1.68-11.17, p=0.002). Reservoir LA strain independently predicted 3-month AF recurrence (OR 0.97; P=0.001), whereas RA-LV coupling index predicted 12-month recurrence (OR 4.33, 95% CI 1.68-11.17; P=0.002).
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