Impact of atrial fibrillation ablation on biatrial strain: Differences between left and right atrial function

Catheter ablation for atrial fibrillation (AF) can improve atrial function; however, little is known about chamber-specific remodeling between the left (LA) and right atria (RA).

We investigated the differences in biatrial strain and its predictive value for atrial arrhythmia (AF/atrial tachycardia [AT]) recurrence.

We retrospectively analyzed patients undergoing initial AF ablation who underwent pre- and postprocedural echocardiography. Atrial strain was quantified by 2-dimensional speckle-tracking echocardiography.

81 patients were analyzed. Both the mean LA (LA reservoir strain [LASr]: 15.3% ± 10.0% to 19.9% ± 8.2%) and RA (RA reservoir strain [RASr]: 18.3% ± 10.8% to 27.3% ± 9.3%) improved significantly after AF ablation (P < .001 for both), with a greater improvement in RASr than LASr (ΔRASr 9.0% ± 10.7% vs ΔLASr 4.5% ± 8.4%; P < .001). Moreover, although LA conduit strain did not change significantly (-9.3% ± 5.6% to -10.3% ± 4.4%; P = .071), RA conduit strain improved significantly (-10.3% ± 6.3% to -14.1% ± 6.2%; P < .001). Postprocedural LASr (hazard ratio 0.92; 95% confidence interval 0.85-1.0; P = .049) and RASr (hazard ratio 0.94; 95% confidence interval 0.89-0.99; P = .016) were independent predictors of AF/AT recurrence. Receiver operating characteristic analysis yielded similar discriminative ability for LASr (area under the curve 0.75; cutoff value; 20.0%) and RASr (area under the curve 0.69; cutoff value 27.0%) (P = .367).

AF ablation led to significant biatrial functional recovery, with RA improvement exceeding that of LA. Both postprocedural LASr and RASr independently predicted AF/AT recurrence, supporting chamber-specific atrial strain as a sensitive marker of reverse remodeling and procedural outcome.