title: Left atrial reservoir function predicts atrial fibrillation recurrence after catheter ablation: a two-dimensional speckle strain study.
abstract: BACKGROUND
  Predictors of atrial fibrillation (AF) recurrence after catheter ablation (CA) are not fully defined. We hypothesized that 2D left atrial (LA) regional strain maps would help identify abnormal atrial substrate that increases susceptibility to AF recurrence post-CA.
  
  
  RESULTS
  Sixty-three patients (63 ± 10 years, 60% male) underwent CA for symptomatic paroxysmal (75%) or persistent (25%) AF. Baseline LA mechanical function determined using speckle tracking echocardiography was compared between those with AF recurrence (AFR) and no recurrence post-CA. Bi-dimensional global and regional maps of LA wall velocity, strain, and strain rate (SR) were obtained during end ejection and early diastole. After 18 ± 12 months of follow-up, 34 patients were free of AFR post-CA. There were no differences in clinical characteristics, LA and LV volumes, and Doppler estimates of LV diastolic function and filling pressures at baseline between patients with recurrent AF and those that maintained sinus rhythm. However, the LA emptying fraction (55 ± 17% vs. 64 ± 14%, p = 0.04), global and regional systolic and diastolic strains, SR, and velocities were reduced in patients with recurrent AF. There was marked attenuation of peak LA lateral wall longitudinal strain (LS; 11 ± 7% vs. 20 ± 14%, p = 0.007) and SR (0.9 ± 0.4 vs.1.3 ± 0.6 s(-1), p = 0.01). Multivariate analysis revealed lateral wall LS (odds ratio = 1.15, 95% CI = 1.02-1.28, p = 0.01) as an independent predictor of AFR.
  
  
  CONCLUSIONS
  Regional LA lateral wall LS is a pre-procedural determinant of AFR in patients undergoing CA, independent of LA enlargement. Characterization of atrial myocardial tissue properties by speckle tracking echo may aid the appropriate selection of adjunctive strategies and prognostication of patients undergoing CA.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA.
authors.forename: Mahek
authors.initials: M
authors.lastname: Mirza
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Caracciolo
authors.forename: Uzma
authors.initials: U
authors.lastname: Khan
authors.forename: Naoyo
authors.initials: N
authors.lastname: Mori
authors.forename: Samir K
authors.initials: SK
authors.lastname: Saha
authors.forename: Komandoor
authors.initials: K
authors.lastname: Srivathsan
authors.forename: Gregory
authors.initials: G
authors.lastname: Altemose
authors.forename: Luis
authors.initials: L
authors.lastname: Scott
authors.forename: Partho
authors.initials: P
authors.lastname: Sengupta
authors.forename: Arshad
authors.initials: A
authors.lastname: Jahangir
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000601:surgery*; D016279:Atrial Function, Left / Q000502:physiology*; D016022:Case-Control Studies; D017115:Catheter Ablation; D016009:Chi-Square Distribution; D015897:Comorbidity; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed