Atrial deformation: the key to maintenance of sinus rhythm in patients with atrial fibrillation?

Abstract

Atrial fibrillation (AF) is the most common serious arrhythmia encountered in clinical practice, and accounts for approximately one-third of all hospitalizations for cardiac rhythm disturbances.1 Consequently, effective therapies for conversion of AF to, and maintenance of, sinus rhythm (SR) have been actively sought. Currently, catheter-based ablation techniques have been shown to be promising in the elimination of AF. However, a significant percentage of patients undergoing catheter ablation have recurrence of AF; in one recent study, only 64% of patients with paroxysmal and 45% of patients with persistent AF were AF-free at 12 months follow-up.2 Other groups have shown that with complete pulmonary vein and posterior left atrial (LA) isolation, up to 63% of chronic AF patients maintained SR at 2 years3. Therefore, there is a great interest in markers, either clinical, biological. or imaging-based, that can predict which patients will maintain SR after catheter ablation and which will revert back to AF. Schneider and colleagues measured tissue Doppler-based strain and strain rate—measures of the degree and rate of LA deformation, respectively—24 h before, 24 h after, and 3 months post-catheter based ablation in 118 patients with either persistent or paroxysmal AF.4 Using catheter-based pulmonary vein isolation employong a ‘double Lasso’ technique, SR was achieved immediately following the procedure in all patients. Of the 118 patients followed-up for a 3-month period after catheter ablation a total of 82 patients (69%) … *Corresponding author. Tel: +1 713 798 2608, Fax: +1 713 798 2751, Email: hishamd{at}bcm.edu