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Updated: Jun 11, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
The Utility of Speckle Tracking Echocardiographic Parameters in Predicting Atrial Fibrillation Recurrence After
Decai Zeng1, Linyan Li1, Shuai Chang1
1Department of Ultrasonic Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China.
Insights
Speckle tracking echocardiography (STE) can predict atrial fibrillation (AF) recurrence after catheter ablation (CA) in non-valvular AF (NVAF) patients. Left atrial stiffness and LA reservoir strain (LASr) are key indicators for risk stratification and guiding follow-up care.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Catheter ablation (CA) is effective for non-valvular atrial fibrillation (NVAF), but recurrence remains a challenge.
- Predicting recurrence is crucial for optimizing patient management and follow-up strategies.
Purpose of the Study:
- To assess the predictive value of speckle tracking echocardiographic (STE) parameters for AF recurrence post-CA.
- To identify specific STE-derived metrics that can stratify risk in NVAF patients undergoing ablation.
Main Methods:
- Prospective study of 380 NVAF patients undergoing CA.
- Baseline left atrial (LA) function assessed using STE within 48 hours pre-ablation.
- Follow-up for a median of 9 months to record AF recurrence.
Main Results:
- Patients with AF recurrence had lower LA reservoir strain (LASr) and higher LA stiffness compared to the non-recurrence group.
- Multivariable analysis identified LA stiffness and LASr as independent predictors of AF recurrence.
- LA stiffness and LASr demonstrated superior predictive performance for 1- and 2-year AF recurrence compared to other parameters.
Conclusions:
- STE-based evaluation of LA function aids in risk stratification for AF recurrence in NVAF patients post-CA.
- LA stiffness and LASr are significant independent predictors of AF recurrence, potentially outperforming traditional morphological parameters.
- These findings can guide personalized follow-up management for NVAF patients after ablation.
Background:
Despite the efficacy of catheter ablation (CA) as a treatment for non-valvular atrial fibrillation (NVAF), many patients still experience atrial fibrillation (AF) recurrence after CA. This study aimed to evaluate the predictive value of speckle tracking echocardiographic (STE) parameters for AF recurrence post-ablation.
Methods:
A total of 380 NVAF patients treated with CA at the First Affiliated Hospital of Guangxi Medical University from January 2020 to March 2023 were prospectively recruited. The mean age was 59.4 ± 10.8 years, and 72.1% were male, including 150 patients (39.5%) with persistent AF and 230 patients (60.5%) with paroxysmal AF. STE was used to evaluate baseline left atrial (LA) function before CA within 48h. Over a median follow-up of 9 (interquartile range, 4-17) months, AF recurrence occurred in 132 patients (34.7%).
Results:
The recurrence group showed lower left ventricular ejection fraction, LA reservoir strain (LASr), and conduit strain (LAScd), but higher LA stiffness than non- recurrence group (all P < 0.05). Multivariable Cox regression identified LA stiffness and LASr as independent risk factors. Time-dependent ROC analysis showed that LA stiffness (AUC 0.768, 95% CI 0.705-0.831) and LASr (AUC 0.755, 95% CI 0.691-0.820) were better at predicting 1-year AF recurrence than other risk factors. For 2-year AF recurrence post-catheter ablation, LA stiffness (AUC 0.866, 95% CI 0.804-0.928) and LASr (AUC 0.860, 95% CI 0.800-0.920) also demonstrated superior predictive performance. Kaplan-Meier curves showed a significant difference in AF recurrence rate for patients with LA stiffness > 0.55 and LASr ≤ 24.3% (Log rank P < 0.01).
Conclusion:
Evaluation of LA function using STE assists in stratifying the risk of AF recurrence in NVAF patients and guiding follow-up management. LASr and LA stiffness are independent predictors of AF recurrence following CA in NVAF patients, and potentially outperforming other morphological parameters.
