Abstract 12438: Predictor of Successful Ablation with Pulmonary Vein Isolation Assessed by Speckle Tracking Echocardiography in Patients with Paroxysmal or Persistent Atrial Fibrillation

Abstract

Background: The strategies of pulmonary vein isolation (PVI) and the predictor of successful ablation by PVI in atrial fibrillation (AF) are not yet elucidated. We assessed the hypothesis that regional remodeling of left atrium (LA) may be responsible for the recurrence of AF after PVI in paroxysmal AF and global remodeling may be responsible in persistent AF.

Methods: Consequent 47 patients with paroxysmal and persistent AF who underwent PVI and the induction test were enrolled. LA emptying function (EF) as a global function, peak strain and strain rate (SR) as a regional function and LA volume (LAV) were measured before ablation using speckle tracking (STE) at sinus rhythm in paroxysmal AF and at AF in persistent AF. In paroxysmal AF, regional function was assessed at 6 segments of LA in apical 2-, 3- and 4-chamber view. The segment with minimum (min) peak strain was selected from these 18 segments as a responsible region for AF. Patients were divided into 2 groups according to the induction test: non-inductive group with paroxysmal AF (n=25, age 62±4) and with persistent AF (n=11, age 65±5), and inductive group with paroxysmal AF (n=6, age 64±6) and with persistent AF (n=5, age 59±8).

Results: In paroxysmal AF, LA total EF and active EF and min peak strain in inductive group were reduced compared to non-inductive group despite no difference in LAV (34±12 vs. 45±9%, 20±9 vs. 30±9% and 2.3±2 vs. 6.3±3.4, p<0.05, respectively). In multivariate analysis, min peak strain was independently associated with AF induction. Using cutoff of 5.2 of min peak strain, sensitivity and specificity was 64 and 100%, AUC was 0.87. In persistent AF, min LAV increased and LAEF and LAEF / min LAV x 100 were reduced in inductive group (72±10 vs. 49±14ml, 29±6 vs. 41±10% and 41±9 vs. 94±54, p<0.05, respectively). Using cutoff of 47 of LAEF / min LAV x 100, the sensitivity and specificity was 100 and 80%, AUC was 0.95.

Conclusion: In paroxysmal AF, LA regional and functional remodeling assessed by min peak strain may be responsible for the emergence of the trigger and motor in LA and the success of PVI. In persistent AF, LA global functional and structural remodeling assessed by LAEF / min LAV may be responsible. We would discriminate a successful ablation of AF by PVI by the assessment of LA volume and function using STE.