Role of CMR-derived atrial deformation analysis in the prediction of atrial fibrillation recurrence rate after pulmonary vein isolation

Abstract

PurposeLeft atrial (LA) dimensions have been identified as anatomical predictors for atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). The value of LA function compared to pure LA anatomical risk prediction for AF recurrence after PVI is not well investigated. Cardiovascular magnetic resonance (CMR) is able to simultaneously assess LA anatomical, tissue and functional markers within one examination. The hypothesis of this explorative study was that CMR-derived LA strain has incremental value for the prediction of AF recurrence after PVI. MethodFifty-two patients with paroxysmal or persistent AF were retrospectively enrolled for CMR (1.5T) prior to PVI. Strain-analysis was derived from standard cine images in 4-, 3- and 2-chamber view. LA function was divided into LA reservoir strain and strain rate (εs and SRs), LA conduit (εe and SRe) and LA booster pump function (εa and SRa). The primary endpoint was recurrence of AF within one year after PVI. ResultsTwelve patients (23 %) presented with AF recurrence. There was no difference in age, LA size as well as LA sphericity index between the groups. Patients with AF recurrence (68.3 ± 5.5 years, 66 % male) showed significantly reduced LA booster pump function compared to the patients without AF recurrence (66.3 ± 10.5 years, 50 % male) (εa: p = 0.015; SRa: p = 0.036). In binomial logistic regression analyses, the only predictor for AF recurrence after PVI was εa (p = 0.033). ConclusionsIn this descriptive study, impaired LA booster pump function predicted AF recurrence one year after PVI. Compared to further LA strain and anatomical parameters, LA booster pump might serve as additional predictor of AF recurrence.