Left atrial strain is a powerful predictor of atrial fibrillation recurrence after catheter ablation: study of a heterogeneous population with sinus rhythm or atrial fibrillation.
OBJECTIVE
Accumulating data show the efficacy of catheter ablation (CA) for atrial fibrillation (AF); however, postoperative recurrence is not uncommon. The aim of this study was to identify predictors of AF recurrence in patients undergoing CA.


RESULTS
We studied 100 patients with symptomatic paroxysmal (68) or persistent (32) AF who underwent CA preceded by transthoracic echocardiographic examination. Of these, 50 had sinus rhythm during echocardiography (Group NSR) and 50 had AF rhythm (Group AF). The left atrial (LA) strain was measured by two-dimensional speckle tracking echocardiography. Echocardiographic parameters were compared between the patients with AF recurrence and no recurrence. During 12 months of follow-up, 26 of 100 patients (11 in Group NSR and 15 in Group AF) had AF recurrence; these patients had significantly longer AF duration, a lower LA global strain (LA-GS), lower LA lateral total strain (LA-LS), and larger maximum LA volume index (LAVImax) than those who maintained sinus rhythm. Multivariate logistic regression identified basal LA-LS and LAVImax as independent predictors of AF recurrence. Furthermore, receiver operating characteristic analyses revealed that basal LA-LS was the most useful parameter for predicting AF recurrence [area under the curve (AUC): 0.84 vs. 0.74 in LAVImax]. Subanalyses showed that LAVImax was another independent predictor of AF recurrence in Group AF, but not in Group NSR, while basal LA-LS was a significant predictor in both groups.


CONCLUSIONS
LA myocardial function assessed by basal LA-LS could predict AF recurrence after CA. Notably, such an assessment could be applicable even during AF rhythm, suggesting its convenience in the clinical setting without defibrillation before analysis.
Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan.
Risako
R
Yasuda
Department of Laboratory Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan muratam@a7.keio.jp.
Mitsushige
M
Murata
Center for Clinical Research, School of Medicine, Keio University, Tokyo, Japan.
Rachel
R
Roberts
Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan.
Hanako
H
Tokuda
Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan.
Yugo
Y
Minakata
Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan.
Keiko
K
Suzuki
Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan.
Hikaru
H
Tsuruta
Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan.
Takehiro
T
Kimura
Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan.
Nobuhiro
N
Nishiyama
Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan.
Kotaro
K
Fukumoto
Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan.
Yoshiyasu
Y
Aizawa
Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan.
Kojiro
K
Tanimoto
Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan.
Seiji
S
Takatsuki
Center for Clinical Research, School of Medicine, Keio University, Tokyo, Japan.
Takayuki
T
Abe
Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan.
Keiichi
K
Fukuda
D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D016279:Atrial Function, Left / Q000502:physiology; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D004452:Echocardiography / Q000379:methods*; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015588:Observer Variation; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D012372:ROC Curve; D012008:Recurrence; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome
LA strain; atrial fibrillation; catheter ablation