title: Left atrial deformation predicts success of first and second percutaneous atrial fibrillation ablation.
abstract: BACKGROUND
  Predictors of second radiofrequency catheter ablation (RFCA) success are not well known. Surgical ablation is accepted for failed first RFCA, but second RFCA has fewer complications.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate left atrial (LA) size and function as potential predictors of second RFCA for atrial fibrillation (AF).
  
  
  METHODS
  Thirty-three healthy volunteers (group I) and 83 patients with symptomatic drug-refractory AF treated with a first RFCA (group II, n = 48) or a second RFCA (group III, n = 35 patients) were included. Echocardiography was performed in all patients in sinus rhythm before RFCA and in all volunteers. LA size and function were measured using longitudinal strain and strain rate during ventricular systole (LASs, LASRs) and during early diastole (LASRe) or late diastole (LASRa) with speckle tracking echocardiography. The effectiveness of RFCA on arrhythmia recurrence was evaluated at 6-month follow-up.
  
  
  RESULTS
  LASs, LASRs, and LASRa were significantly lower in group III patients compared to other groups (P < .001 for all). LA diameter or volumes did not predict success after RFCA. LASs was an independent predictor of arrhythmia suppression after a first RFCA and after a second RFCA, with the best cutoff at LASs >20% (sensitivity 86%, specificity 70%) and LASs >12% (sensitivity 84%, specificity 90%), respectively.
  
  
  CONCLUSIONS
  LA myocardial deformation imaging is a reliable tool for predicting success after a first and a second RFCA. These parameters could improve candidate selection, especially for a second RFCA.
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clinic; IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Sílvia
authors.initials: S
authors.lastname: Montserrat
authors.affiliation: Advanced Center for Chronic Diseases, Pontificia Universidad Católica de Chile, Comisión Nacional de Ciencia y Tecnologia FONDAP.
authors.forename: Luigi
authors.initials: L
authors.lastname: Gabrielli
authors.affiliation: ICREA-Universitat Pompeu Fabra, Barcelona, Spain, and IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer.
authors.forename: Bart
authors.initials: B
authors.lastname: Bijnens
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clinic; IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Roger
authors.initials: R
authors.lastname: Borràs
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clinic; IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Berruezo
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clinic; IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Sílvia
authors.initials: S
authors.lastname: Poyatos
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clinic; IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clinic; IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Lluis
authors.initials: L
authors.lastname: Mont
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clinic; IDIBAPS, University of Barcelona, Barcelona, Spain. Electronic address: msitges@clinic.ub.es.
authors.forename: Marta
authors.initials: M
authors.lastname: Sitges
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D016279:Atrial Function, Left / Q000502:physiology; D064752:Atrial Remodeling; D016022:Case-Control Studies; D017115:Catheter Ablation; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012008:Recurrence; D019233:Retreatment; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: Atrial fibrillation; Atrial function; Predictors; Second catheter ablation; Strain; Strain rate