Association between left atrial strain and peri-operative stroke in catheter ablation for atrial fibrillation

Abstract

Abstract Background It has been reported that left atrial (LA) phasic function, evaluated by LA strain, is associated with cardiogenic stroke in patients with atrial fibrillation (AF). There are no well-established echocardiographic findings to predict peri-operative stroke in AF ablation. Purpose The aim is to evaluate between LA strain and peri-operative stroke in AF ablation. Methods This study included 103 consecutive AF patients (90 paroxysmal and 13 non-paroxysmal AF cases) who underwent initial cryo-ablation without interruption of peri-operative anticoagulation from January 2019 to August 2022. Pre-operative echocardiography was used to measure the LA strain items: LA reservoir strain, contractile strain, and conduit strain in sinus rhythm. Twenty-three patients were excluded due to AF rhythm and atrial septal defect. Peri-operative stroke was detected by using magnetic resonance imaging on the day after ablation. Results Peri-operative stroke occurred in 9 patients (11.3%), and there was no symptomatic stroke. In univariate analysis, age (69.6 ± 4.8 years vs. 64.2 ± 10.9 years, p<0.05) and log brain natriuretic peptide (1.61 ± 0.26 vs. 1.32 ± 0.42 p<0.05) were significantly higher in the stroke group. On the other hand, LA reservoir strain (20.9 ± 5.6% vs. 29.8 ± 8.3%, p<0.01) and LA conduit strain (10.9 ± 2.3% vs. 15.9 ± 7.0%, p<0.01) in the stroke group was significantly lower compared with the non-stroke group. There were no significant differences in the rate of intra-operative electrical cardioversion and other clinical parameters between both groups. Receiver operating characteristic curve analysis revealed that LA reservoir strain cut-off value of 22.7% provided a c-statistic of 0.82 for predicting peri-operative stroke in AF ablation. Conclusions LA reservoir strain is closely associated with peri-operative stroke in AF ablation.ROC curve analysis