Atrial strain analysis predicts atrial arrhythmias recurrence following cavotricuspid isthmus ablation of typical atrial flutter

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Abstract Background The evaluation of left atrial (LA) and right atrial (RA) function by two-dimensional speckle-tracking echocardiography has recently appeared as a valuable method to predict atrial arrhythmias (AA) recurrence after electrical cardioversion or transcatheter ablation. However, there are no similar studies performed in patients with typical atrial flutter (AFL). Aims The aim of our study is to assess the ability of RA and LA strain reservoir (RASr and LASr) to predict recurrence following cavotricuspid isthmus ablation (CTIA) for typical AFL. Methods Consecutive AFL patients who underwent CTIA at our hospital from January 2020 to May 2023 were retrospectively enrolled. Transthoracic echocardiography was performed within one month before CTIA and strain analysis was performed off-line. At follow-up, AA recurrence was recorded reviewing medical records. Results A total of 62 patients were analysed (mean age 64.8±13.2 years, 29% females). At a median follow up of 12.1 months (IQR: 7–18.4), AA recurrence occurred in 21 (33.8%). The study endpoint occurred mainly among females (p=0.021), patients who developed atrial fibrillation (AF) during CTIA and patients with lower RASr and LASr values (both p<0.001). At multivariable Cox regression analysis, only RASr and LASr remained independent predictors of AA recurrence (OR 0.904, 95% CI [0.831–0.984], p=0.02 and OR 0.919, 95% CI [0.852–0.992], p= 0.03, respectively). At ROC curve analysis, RASr and LASr showed similar and satisfactory ability to predict AA recurrence with optimal cut-off values of 16.8% and 17.7%, respectively. At survival analysis, RASr >16.8% and LASr >17.7% were associated with significantly higher freedom from AA (log rank p=0.001 and p=0.002, respectively). Conclusion In our study, lower values of both RASr and LASr resulted to be independent predictors of AA recurrence following CTIA for typical AFL. Therefore, pre-ablation atrial strain analysis may help in the detection of patients at higher risk of recurrence, which could benefit from closer follow up visits and prolonged antiarrhythmic therapy.