Abstract 6138: Two-Dimensional Atrial Strain and Strain Rate Predict Maintenance of Sinus Rhythm After Pulmonary Vein Ablation in Patients with Atrial Fibrillation

Abstract

Introduction A novel method to measure strain and strain rate from standard 2-dimensional(2D) has been developed. However, clinical usefulness of 2D atrial strain and strain rate has been not yet investigated. Hypothesis We assessed the hypothesis that 2D strain and strain rate might be reduced in patients with atrial fibrillation (AF) and predictive of maintenance of sinus rhythm after AF ablation. Methods Echocardiographic examinations were performed in 44 patients with lone AF before AF ablation. Using a dedicated software package, bidimensional acquisitions were analyzed to measure longitudinal strain and strain rate in apical 4- and 2-chamber views. Maintenance of sinus rhythm after AF ablation was assessed during a 9 months follow-up. 2D left atrial(LA) strain and strain rate values in AF patients were compared with those of age- and sex-matched referents(N=40). Moreover, clinical and echocardiographic parameters of patients with maintenance of sinus rhythm (n=30) over the follow-up period were compared with those from patients with AF recurrence (n=14). Results All components of strain and strain rate were significantly reduced in AF patients. Average LA longitudinal strain and strain rate in patients with AF and referents were 28.1 ± 8.7 % versus 40.5 ± 6.4 and 1.8 ± 0.5 versus 2.4 ± 0.9, respectively (all p < 0.001). The individual predictors of sinus rhythm maintenance after AF ablation were paroxysmal AF(80 vs. 35.7%, p = 0.007), duration of AF (3.5 ± 3.1 vs. 5.9 ± 3.4 years, p=0.037), LA volume index(29±8 vs. 36±14ml/m2, p=0.045), average LA longitudinal strain (30.9±7.9 vs. 21.9 ± 7.3, p=0.001) and strain rate (2.0 ± 0.4 vs.1.6±0.6, p=0.008) peak systolic values. Average LA longitudinal strain parameter (OR 0.85, 95% CI 0.74–0.97, p=0.016) was confirmed as independent predictor of sinus rhythm maintenance by multivariate analysis, with a contribution from paroxysmal AF (OR 8.17, 95% CI 1.03–64.85, p=0.047). Average interobserver and intraobserver variabilities for strain and strain rate were 9.2%, 10.3%, 13.2%, and 14.1%, respectively. Conclusions Patients with higher atrial strain appear to have a greater likelihood of maintenance of sinus rhythm after AF ablation. 2D strain of LA may be helpful to select candidates of AF ablation.