Evaluation of left atrial strain imaging and integrated backscatter as predictors of recurrence in patients with paroxysmal, persistent, and long-standing persistent atrial fibrillation undergoing catheter ablation

Pedro Garcia Brás, Pedro Silva Cunha, Ana Teresa Timóteo, Guilherme Portugal, Ana Galrinho, Sérgio Laranjo, Madalena Coutinho Cruz, Bruno Valente, Pedro Rio, Ana Sofia Delgado, Margarida Paulo, Manuel Brás, Rui Cruz Ferreira, Mário Martins Oliveira, Luísa Moura Branco

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

Background: Impaired left atrial (LA) strain predicts atrial fibrillation (AF) recurrence after catheter ablation (CA), but currently there is no cut-off to guide patient selection for CA. Integrated backscatter (IBS) is a promising tool for noninvasive quantification of myocardial fibrosis. The aim of this study was to compare LA strain and IBS between paroxysmal, persistent, and long-standing persistent AF and evaluate their association with AF recurrence after CA. Methods: Analysis of consecutive patients with symptomatic paroxysmal and persistent AF who underwent CA. LA phasic strain, strain rate and IBS were assessed by two-dimensional speckle-tracking at baseline. Results: We analyzed 78 patients, 31% with persistent AF (46% long-standing AF), 65% male, mean age 59 ± 14 years, who underwent CA and were followed-up for 12 months. AF recurrence occurred in 22 (28%) patients. LA phasic strain parameters were significantly impaired in patients with AF recurrence and were independent predictors of AF recurrence in a multivariable analysis. LA reservoir strain (LASr) < 18% predicted AF recurrence with 86% sensitivity and 71% specificity, with a higher predictive power compared to LA volume index (LAVI). LASr < 22% in paroxysmal AF and LASr < 12% in persistent AF correlated with AF recurrence. Increased IBS was a predictor of AF recurrence in patients with paroxysmal AF. Conclusion: LA phasic strain parameters were predictors of AF recurrence after CA, independently of LAVI and AF subtype. LASr < 18% showed a higher predictive power compared to LAVI. Further studies are needed to investigate the role of IBS as a predictor of AF recurrence. Graphical abstract: [Figure not available: see fulltext.]

Original languageEnglish
Pages (from-to)479 - 492
JournalJournal of Interventional Cardiac Electrophysiology
Volume67
Issue number3
Early online date7 Jul 2023
DOIs
Publication statusPublished - Apr 2024

Keywords

  • Atrial fibrillation catheter ablation
  • Atrial fibrillation recurrence
  • Integrated backscatter
  • Left atrial strain
  • Speckle tracking echocardiography

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