title: Clinical Relevance of Left Atrial Strain to Predict Recurrence of Atrial Fibrillation after Catheter Ablation: A Meta-Analysis.
abstract: BACKGROUND
  The purpose of this meta-analysis was to analyze the clinical relevance of left atrial (LA) strain to predict recurrence of atrial fibrillation (AF) after catheter ablation (CA).
  
  
  RESULTS
  We searched in different databases (Medline, EMBASE, and Cochrane) prospective studies that analyzed LA strain before CA. Eight studies (2 with only paroxysmal AF and 6 with mixed population of paroxysmal and persistent AF) were included in the final analysis (total patient number = 686). Patients with recurrence of AF were principally characterized by lower LA strain in comparison with those without AF recurrence (mean 18.4% [range 8.8-24.5%] versus 25.3% [13.6-32.7%], weighted mean difference -4.89% [95% CI -5.83% to -3.95%], P < 0.001). In addition, receiver operating curves shown that LA strain was strongly associated with recurrence of AF after CA (weighted mean: AUC 0.798 [95% CI 0.700-0.943], cutoff 22.8% [18.8-30%], sensitivity 78% [65-86%], and specificity 75% [66-100%]). In line, these results were similar using LA strain with QRS-analysis and P-analysis as well as using different software package such as Echo-Pac, QLab, TomTec, and VVI.
  
  
  CONCLUSIONS
  In patients with AF candidate for CA, the analysis of the LA using LA strain could be of great usefulness to identify patients with high risk of AF recurrence. Nonetheless, further studies are needed to establish the clinical relevance of LA strain in patients with persistent AF.
authors: Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China.
authors: Xin-Xin
authors: XX
authors: Ma
authors: Department of Internal Medicine and Cardiology, Charité University Hospital (Campus Virchow Klinikum), Berlin, Germany.
authors: Leif-Hendrik
authors: LH
authors: Boldt
authors: Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China.
authors: Yue-Li
authors: YL
authors: Zhang
authors: Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China.
authors: Meng-Ruo
authors: MR
authors: Zhu
authors: Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China.
authors: Bing
authors: B
authors: Hu
authors: Department of Internal Medicine and Cardiology, Charité University Hospital (Campus Virchow Klinikum), Berlin, Germany.
authors: Abdul
authors: A
authors: Parwani
authors: Department of Internal Medicine and Cardiology, Charité University Hospital (Campus Virchow Klinikum), Berlin, Germany.
authors: Evgeny
authors: E
authors: Belyavskiy
authors: Department of Internal Medicine and Cardiology, Charité University Hospital (Campus Virchow Klinikum), Berlin, Germany.
authors: Aravind K
authors: AK
authors: Radha Krishnan
authors: Department of Internal Medicine and Cardiology, Charité University Hospital (Campus Virchow Klinikum), Berlin, Germany.
authors: Maximilian
authors: M
authors: Krisper
authors: Department of Internal Medicine and Cardiology, Charité University Hospital (Campus Virchow Klinikum), Berlin, Germany.
authors: Clemens
authors: C
authors: Köhncke
authors: Department of Internal Medicine and Cardiology, Meoclinic, Berlin, Germany.
authors: Engin
authors: E
authors: Osmanoglou
authors: Department of Internal Medicine and Cardiology, Charité University Hospital (Campus Virchow Klinikum), Berlin, Germany.
authors: Martin
authors: M
authors: Kropf
authors: Department of Internal Medicine and Cardiology, Charité University Hospital (Campus Virchow Klinikum), Berlin, Germany.
authors: Philipp
authors: P
authors: Lacour
authors: Department of Internal Medicine and Cardiology, Charité University Hospital (Campus Virchow Klinikum), Berlin, Germany.
authors: Florian
authors: F
authors: Blaschke
authors: Department of Internal Medicine and Cardiology, Charité University Hospital (Campus Virchow Klinikum), Berlin, Germany.
authors: Frank
authors: F
authors: Edelmann
authors: Department of Internal Medicine and Cardiology, Charité University Hospital (Campus Virchow Klinikum), Berlin, Germany.
authors: Carsten
authors: C
authors: Tschöpe
authors: Department of Internal Medicine and Cardiology, Charité University Hospital (Campus Virchow Klinikum), Berlin, Germany.
authors: Wilhelm
authors: W
authors: Haverkamp
authors: Department of Internal Medicine and Cardiology, Charité University Hospital (Campus Virchow Klinikum), Berlin, Germany.
authors: Elisabeth
authors: E
authors: Pieske-Kraigher
authors: Department of Internal Medicine and Cardiology, Charité University Hospital (Campus Virchow Klinikum), Berlin, Germany.|Department of Internal Medicine and Cardiology, German Heart Institute, Berlin, Germany.
authors: Burkert
authors: B
authors: Pieske
authors: Department of Internal Medicine and Cardiology, Charité University Hospital (Campus Virchow Klinikum), Berlin, Germany.
authors: Daniel A
authors: DA
authors: Morris
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D018450:Disease Progression; D055119:Elastic Modulus; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D011379:Prognosis; D012008:Recurrence; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
keywords: atrial fibrillation; catheter ablation; left atrial; strain