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Published on: July 20, 2022
Left Atrial Function Predicts Atrial Arrhythmia Recurrence Following Ablation of Long-Standing Persistent Atrial
Habib Rehman Khan1, Haci Yakup Yakupoglu2, Ines Kralj-Hans2
1London Health Sciences Centre, University of Western Ontario, London, Canada (H.R.K.).
Insights
Following ablation for persistent atrial fibrillation (AF), improved left atrial (LA) function, particularly LA contractile strain, predicts rhythm maintenance. Enhanced LA function post-ablation is key to preventing AF recurrence.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Imaging
Background:
- Long-standing persistent atrial fibrillation (AF) poses challenges for ablation success.
- Left atrial (LA) function is crucial in AF pathophysiology and recurrence.
- The CASA-AF trial investigates catheter vs. surgical ablation for persistent AF.
Purpose of the Study:
- To assess left atrial (LA) function after ablation for persistent AF.
- To determine the impact of LA function on AF recurrence.
- To compare outcomes between catheter and surgical ablation in the CASA-AF trial.
Main Methods:
- Echocardiography (2D, speckle tracking) evaluated LA structure and function (reservoir, conduit, contractile strain).
- Left ventricular diastolic function assessed via transmitral Doppler and tissue Doppler.
- Continuous rhythm monitoring used implantable loop recorders.
Main Results:
- Eighty-three patients analyzed; 30 maintained sinus rhythm, 53 had recurrence.
- Improved LA emptying fraction, reservoir strain, and contractile strain observed in sinus rhythm patients.
- LA contractile strain at 3 months post-ablation independently predicted AF recurrence.
Conclusions:
- Ablation for persistent AF improves LA function, with greater improvement in those maintaining sinus rhythm.
- LA contractile strain is the primary determinant of AF recurrence post-ablation.
- These findings highlight the importance of LA function assessment in AF management.
Background:
Left atrial (LA) function following catheter or surgical ablation of de-novo long-standing persistent atrial fibrillation (AF) and its impact on AF recurrence was studied in patients participating in the CASA-AF trial (Catheter Ablation vs. Thoracoscopic Surgical Ablation in Long Standing Persistent Atrial Fibrillation).
Methods:
All patients underwent echocardiography preablation, 3 and 12 months post-ablation. LA structure and function were assessed by 2-dimensional volume and speckle tracking strain measurements of LA reservoir, conduit, and contractile strain. Left ventricular diastolic function was measured using transmitral Doppler filling velocities and myocardial tissue Doppler velocities to derive the e', E/e', and E/A ratios. Continuous rhythm monitoring was achieved using an implantable loop recorder.
Results:
Eighty-three patients had echocardiographic data suitable for analysis. Their mean age was 63.6±9.7 years, 73.5% were male, had AF for 22.8±11.6 months, and had a mean LA maximum volume of 48.8±13.8 mL/m2. Thirty patients maintained sinus rhythm, and 53 developed AF recurrence. Ablation led to similar reductions in LA volumes at follow-up in both rhythm groups. However, higher LA emptying fraction (36.3±10.6% versus 27.9±9.9%; P<0.001), reservoir strain (22.6±8.5% versus 16.7±5.7%; P=0.001), and contractile strain (9.2±3.4% versus 5.6±2.5%; P<0.001) were noted in the sinus rhythm compared with AF recurrence group following ablation at 3 months. Diastolic function was better in the sinus rhythm compared with the AF recurrence group with an E/A ratio of 1.5±0.5 versus 2.2±1.2 (P<0.001) and left ventricular E/e' ratio of 8.0±2.1 versus 10.3±4.1 (P<0.001), respectively. LA contractile strain at 3 months was the only independent predictor of AF recurrence.
Conclusions:
Following ablation for long-standing persistent AF, improvement in LA function was greater in those who maintained sinus rhythm. LA contractile strain at 3 months was the most important determinant of AF recurrence following ablation.
Registration:
URL: https://www.
Clinicaltrials:
gov; Unique identifier: NCT02755688.
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