Abstract 13210: Left Atrial Global Longitudinal Strain in the Prediction of Sinus Rhythm Maintenance after Catheter Ablation for Atrial Fibrillation

Abstract

Background: Left atrial (LA) strain (ε) is a sensitive measure of LA mechanics. However, its relationship with maintenance of sinus rhythm after catheter ablation for patients with atrial fibrillation (AF) is not well-established.

Methods: In 202 patients with AF (paroxysmal 117, persistent 85), we performed comprehensive echocardiography with assessment of global LA longitudinal ε (i.e. “LAε”) by velocity vector imaging (Siemens) average from apical 4- and 2-chamber views before ablation (median 48 [IQR 1-94] days).

Results: After median 8.5 [IQR 4-16] months’ follow up, 124 patients (61%) had maintained sinus rhythm and 78 patients (39%) had recurrence of AF. In our study cohort (age 60 ± 11 years, LVEF 54 ± 12%, median BNP 71 pg/mL), the mean peak negative, peak positive and total LAε were -8.0±4.4%, 13.9±6.9%, 18.2±9.3%, respectively. There was significantly lower LAε_total in patients with AF recurrence than in patients who maintained sinus rhythm (14.6±8.9% vs. 20.5±8.9, p<0.0001). LAε_total predicted AF recurrence (HR: 1.044 [95% CI: 1/015-1.073, p<0.003). Diminished baseline strain (LAε_total <12.585%) predicted AF recurrence after adjustment for age, rhythm at echocardiogram, type of AF, prior ablation, maximal LA volume index, and BNP (HR: 5.144 [95% CI: 2.518-10.509], p<0.001). Moreover, LAε provided an incremental value in predicting outcome of PVI over LA size and BNP (increment in global χ²=5.77, p<0.05).

Conclusion: In patients AF, diminished baseline LAε is associated with AF recurrence, regardless of LA enlargement and BNP.