Incremental value of left atrial strain to predict atrial fibrillation recurrence after cryoballoon ablation

Abstract

Abstract Background Cryoballoon ablation (CBA) has emerged a one of the safest and efficient therapeutic options for atrial fibrillation (AF) [1]. However, AF recurrence rate after CBA remains as high as 25–30%, leading to increased rates of complications and repeated procedures [2]. Left atrial (LA) structural remodeling, defined as LA dilation has been proposed as a predictor of AF recurrence after CBA [2]. However, LA mechanical dysfunction might appear even before the LA enlargement and might be a more sensitive prognostic indicator of AF recurrence [3–5]. The early recognition of LA dysfunction might play a key role in identifying patients at higher risk of AF recurrence after CBA, even in patients without a dilated LA. Purpose The purpose of this study was to evaluate the additional value of LA function, assessed using speckle tracking echocardiography to predict AF recurrence after CBA. Methods Consecutive patients with paroxysmal/persistent AF undergoing CBA were prospectively included. Echocardiography was performed before CBA, according to standard recommendations. Blanking period was defined as the first three months post-ablation. The primary endpoint was AF recurrence after the blanking period. Results One hundred seventy two patients (62.2±12.2 years, 61% male) were included in the analysis. During the follow-up period of 11.7±1.6 months, 50 (29%) patients had AF recurrence. In the overall study population, peak atrial longitudinal strain (PALS) ≤17% had the highest incremental predictive value for AF recurrence (HR=9.45, 95% CI: 3.17–28.13, chi-square to improve 37% increase, p<0.001) (Figure 1). In patients with non-dilated LA (119 (69.1%) patients), AF recurrence occurred in 24 (20.2%) patients. In this category of patients, PALS ≤17% remained an independent predictor of AF recurrence (HR=5.39, 95% CI: 1.66–17.52, p=0.005). Conclusions This study showed that LA function assessed by PALS provided an additional predictive value for AF recurrence after CBA, over LA enlargement. In patients with non-dilated LA, PALS remained an independent predictor of AF recurrence. These findings emphasize the added value of LA strain, suggesting that it should be implemented in the systematic evaluation of the AF patients before CBA. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Universitair Ziekenhuis Brussel - Wetenschappelijk Fonds Willy Geps of the UZ Brussel