title: Left atrial deformation imaging with ultrasound based two-dimensional speckle-tracking predicts the rate of recurrence of paroxysmal and persistent atrial fibrillation after successful ablation procedures.
abstract: OBJECTIVE
  Since predictors of recurrence of atrial fibrillation (AF) after ablation procedures are poorly defined, this prospective study was conducted to assess the value of left atrial (LA) deformation imaging with two-dimensional speckle-tracking (2D-ST) to predict AF recurrences after successful ablation procedures.
  
  
  RESULTS
  One hundred and three consecutive patients (age 58.1 ± 16.6 years, 72.8% male) with AF (76 paroxysmal, 27 persistent) and 30 matched controls underwent transthoracic echocardiography and 2D-ST-LA-deformation analysis with assessment of LA-radial and LA-longitudinal strain (Sr, Sl), and velocities derived from the apical 4- and 2-chamber views (4CV, 2CV). AF recurrence was assessed during 6 months of follow-up. For determination of AF-related LA changes, AF patients were compared to controls and patients with AF recurrences after ablation procedures (n = 30, 29.1%) were compared with patients who maintained sinus rhythm (n = 73, 70.9%). Atrial deformation capabilities were significantly reduced (P < 0.0005) in patients with AF (4CVSl 17.8 ± 13.5%; 4CVSr 22.3 ± 14.9%; 4CV-velocities 2.53 ± 0.97 seconds) when compared with controls (4CVSl 31.3 ± 12.4%; 4CVSr 30.3 ± 9.1%; 4CV-velocities 3.48 ± 1.01 cm/s). Independent predictors for AF recurrence after ablation procedures were 2CV-LA-global-strain (Sr, P = 0.03; Sl, P = 0.003), 4CV-LA-gobal-strain (Sr, P = 0.03; Sl, P = 0.02), and regional LA-septal wall-Sl (P = 0.008). LA-global-strain parameters were superior to regional LA function analysis for the prediction of AF recurrences, with cutoff values (cov), hazard ratios (HR), positive and negative predictive values (PPV, NPV) were: 4CVSl cov, 10.79% (HR 27.8, P < 0.0005; PPV 78.8%, NPV 93.9%), 4CVSr cov, -16.65% (HR 24.8, P < 0.0005; PPV 69.4%, NPV 96.6%), 2CVSl cov, 12.31% (HR 22.7, P < 0.0005; PPV 75.8%, NPV 95.3%), and 2CVSr cov, -14.9% (HR 12.9, P < 0.0005; PPV 64.3%, NPV 93.2%).
  
  
  CONCLUSIONS
  Compared with controls, AF itself seems to decrease LA deformation capabilities. The assessment of global LA strain with 2D-ST identifies patients with high risk for AF recurrence after ablation procedures. This imaging technique may help to improve therapeutic guiding for patients with AF.
authors.affiliation: Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany. christoph.hammerstingl@ukb.uni-bonn.de
authors.forename: Christoph
authors.initials: C
authors.lastname: Hammerstingl
authors.forename: Marieke
authors.initials: M
authors.lastname: Schwekendiek
authors.forename: Diana
authors.initials: D
authors.lastname: Momcilovic
authors.forename: Robert
authors.initials: R
authors.lastname: Schueler
authors.forename: Jan-Malte
authors.initials: JM
authors.lastname: Sinning
authors.forename: Jan W
authors.initials: JW
authors.lastname: Schrickel
authors.forename: Erica
authors.initials: E
authors.lastname: Mittmann-Braun
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.forename: Lars
authors.initials: L
authors.lastname: Lickfett
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D016279:Atrial Function, Left; D017115:Catheter Ablation; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012008:Recurrence; D015203:Reproducibility of Results