Predictive role of left atrial strain in atrial fibrillation recurrence following electrical cardioversion: Results from a 24-month follow-up

Introduction. Left atrial (LA) strain has emerged as a potential marker of atrial mechanical dysfunction and recurrence risk after electrical cardioversion (ECV). This study evaluated the prognostic value of baseline LA strain parameters and LA stiffness index (LASI) for atrial fibrillation (AF) recurrence during 24-month follow-up, with particular emphasis on recurrence timing. Methods. This prospective observational follow-up study included 31 patients with persistent AF who underwent successful ECV. Baseline echocardiographic assessment included LA reservoir, conduit, and contractile strain, LASI, E/e', and left atrial volume index (LAVI). Patients were followed at 3, 6, 12, and 24 months. AF recurrence was analysed as overall recurrence during follow-up and according to the interval of first documented recurrence. Results. During 24 months, AF recurred in 18 patients (58.1%). Patients with recurrence had lower baseline LA reservoir, conduit, and contractile strain and higher LASI and E/e', whereas LAVI did not differ significantly between groups. All three strain components and LASI showed good discrimination for 24-month recurrence. LA contractile strain was the only parameter that significantly distinguished early from late recurrence and showed the largest correlation coefficient with recurrence interval. Its discriminatory performance for early versus late recurrence was high (AUC 0.910). Conclusion. Baseline LA functional impairment was associated with AF recurrence after successful ECV. LA contractile strain showed a particularly close relationship with recurrence timing and may provide additional prognostic information beyond the assessment of recurrence risk alone.