Left atrial reservoir function predicts atrial fibrillation recurrence after catheter ablation: A two-dimensional speckle strain study

Mahek Mirza, Giuseppe Caracciolo, Uzma Khan, Naoyo Mori, Samir K. Saha, Komandoor Srivathsan, Gregory Altemose, Luis Scott, Partho Sengupta, Arshad Jahangir

Research output: Contribution to journalArticle

65 Scopus citations

Abstract

Background Predictors of atrial fibrillation (AF) recurrence after catheter ablation (CA) are not fully defined. We hypothesized that 2D left atrial (LA) regional strain maps would help identify abnormal atrial substrate that increases susceptibility to AF recurrence post-CA. Methods and Results Sixty-three patients (63±10 years, 60% male) underwent CA for symptomatic paroxysmal (75%) or persistent (25%) AF. Baseline LA mechanical function determined using speckle tracking echocardiography was compared between those with AF recurrence (AFR) and no recurrence post-CA. Bi-dimensional global and regional maps of LA wall velocity, strain, and strain rate (SR) were obtained during end ejection and early diastole. After 18±12 months of follow-up, 34 patients were free of AFR post-CA. There were no differences in clinical characteristics, LA and LV volumes, and Doppler estimates of LV diastolic function and filling pressures at baseline between patients with recurrent AF and those that maintained sinus rhythm. However, the LA emptying fraction (55±17% vs. 64±14%, p=0.04), global and regional systolic and diastolic strains, SR, and velocities were reduced in patients with recurrent AF. There was marked attenuation of peak LA lateral wall longitudinal strain (LS; 11±7% vs. 20±14%, p=0.007) and SR (0.9±0.4 vs.1.3±0.6 s -1, p=0.01). Multivariate analysis revealed lateral wall LS (odds ratio=1.15, 95% CI=1.02-1.28, p= 0.01) as an independent predictor of AFR. Conclusions Regional LA lateral wall LS is a pre-procedural determinant of AFR in patients undergoing CA, independent of LA enlargement. Characterization of atrial myocardial tissue properties by speckle tracking echo may aid the appropriate selection of adjunctive strategies and prognostication of patients undergoing CA.

Original languageEnglish (US)
Pages (from-to)197-206
Number of pages10
JournalJournal of Interventional Cardiac Electrophysiology
Volume31
Issue number3
DOIs
StatePublished - Sep 2011

Keywords

  • Atrial fibrillation
  • Atrial size
  • Catheter ablation
  • Strain and strain rate

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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