Total Atrial Conduction Time as a Predictor of Left Atrial Functional Recovery in Atrial Fibrillation

Catheter ablation (CA) leads to the recovery of left atrial (LA) function in patients with atrial fibrillation (AF), although the degree varies substantially among individuals. PA-TDI duration, the time delay between the P-wave on the electrocardiogram to the peak A'-wave on tissue-Doppler imaging of the lateral LA wall is an echocardiographic measure that reflects structural and electrical LA remodeling.

The objective of the study was to investigate whether the preprocedural PA-TDI duration could predict LA functional recovery after CA.

We studied 109 AF patients in sinus rhythm at preprocedural echocardiography, who underwent their first CA. PA-TDI duration was measured by tissue Doppler imaging from the apical four-chamber view. Speckle-tracking echocardiography was performed before and 6 months after CA to evaluate LA reservoir strain (LARS).

The median (25th-75th percentile) PA-TDI duration was 144 (128-162) ms. There was no significant difference in age, sex, and AF risk factors between patients with longer PA-TDI duration (≥144 ms) and those with shorter PA-TDI duration (<144 ms). The median follow-up was 465 (273-746) days. LARS was significantly improved at 6 months after CA (29.7% ± 7.9% to 32.1% ± 6.7%; P < 0.001). Preprocedural PA-TDI duration was significantly associated with LARS at 6 months after CA independent of AF type, baseline LARS, and recurrent AF (standardized beta -0.20; 95% CI: -0.10 to -0.01; P = 0.013). Combination of baseline LARS and PA-TDI duration provided enhanced predictive value for postprocedural LA function (P < 0.001).

The measurement of PA-TDI duration provided valuable information for LA functional recovery in AF patients who underwent CA.