Does left atrial strain measured by 2D speckle-tracking echocardiography predict the recurrence of atrial arrhythmias in patients with persistent atrial fibrillation undergoing catheter ablation?
Pre-procedural left atrial strain <10% strongly predicts recurrence of atrial arrhythmias after catheter ablation for persistent atrial fibrillation, identifying patients who may not benefit from the procedure.
INTRODUCTION: Success rates of catheter ablation (CA) of persistent atrial fibrillation (AF) are very variable. Identifying patients in whom sinus rhythm maintenance cannot be achieved after CA is a critical issue. METHODS: 2D speckle-tracking echocardiography was performed before the first CA procedure in consecutive patients with persistent AF. Left atrial (LA) strain was correlated with recurrence of atrial arrhythmias during the follow-up period of 15 months after one CA procedure with or without antiarrhythmic drugs (primary endpoint). In a secondary analysis, recurrences after two CA procedures were analysed. RESULTS: 102 patients were included. Patients with recurrence of atrial arrhythmias after one CA procedure (n=55) had significantly lower LA strain than those without recurrence (LA strain 9.7±2.4% vs 16.2±3.0%; p14.5% (97.7%, 42.1% and 10.3%, respectively; p<0.001). In Cox regression analysis including age, comorbidities, left ventricular dysfunction and LA enlargement, low LA strain (<10%) was the strongest factor associated with recurrence of AF (HR 6.4 (2.4-16.9), p<0.001). Even after inclusion of a second CA procedure, LA strain <10% maintained a high predictive value for recurrence of atrial arrhythmias (86.4% (95% CI 73.3% to 93.6%)). CONCLUSION: In patients with persistent AF, LA strain imaging could be very useful to select those patients who have a high risk of not benefiting from CA.
Parwani et al. (Sat,) studied this question.