ISSN 2996-8215
International Journal of Cardiology | Vol. 12, No. 5, May 2021 | pp. 33–40
DOI: 10.46882/2021/IJC/000146
Original Research Article
Speckle-Tracking Echocardiography Derived Left Atrial Reservoir Strain for Predicting Arrhythmic Recurrence Post-PVI
Sven Lindstrom¹, Ingrid Johansson¹, Anders Nielsen²
¹Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
²Department of Clinical Physiology, Aarhus University Hospital, Aarhus, Denmark
Abstract:
Catheter ablation using pulmonary vein isolation is an effective rhythm control strategy for paroxysmal atrial fibrillation (AF), but anatomical left atrial (LA) diameter alone poorly predicts recurrence. Left atrial reservoir strain (LA-RS) evaluated by speckle-tracking echocardiography offers a direct indicator of structural remodeling and compliance. This study investigated the independent association between baseline LA-RS and long-term arrhythmia recurrence post-catheter ablation. We prospectively enrolled 150 patients with symptomatic paroxysmal AF scheduled for radiofrequency catheter ablation. LA-RS was analyzed off-line using apical four- and two-chamber views before the intervention. The primary endpoint was any documented recurrence of atrial tachyarrhythmia lasting longer than 30 seconds after a 90-day blanking period over a 24-month follow-up. Arrhythmia recurrence occurred in 48 patients (32.0%). Baseline mean LA-RS was significantly lower in patients with recurrent events compared to those who maintained sinus rhythm (18.4% ± 3.2% vs. 28.5% ± 4.1%, p < 0.001). Multivariable Cox proportional hazards regression identified a depressed baseline LA-RS (absolute value less than 20%) as a powerful independent predictor of AF recurrence (hazard ratio: 2.45, 95% CI: 1.34–4.48, p = 0.003), whereas conventional LA volume indexing lost statistical significance. No major procedural access complications occurred. Left atrial reservoir strain is strongly and independently associated with atrial fibrillation recurrence following catheter ablation, outperforming traditional volumetric metrics for predicting long-term rhythm stability.
Keywords: Atrial fibrillation, Catheter ablation, Speckle-tracking echocardiography, Left atrial strain, Recurrence, Remodeling
Received: February 14, 2021; Revised: March 28, 2021; Accepted: April 15, 2021; Published: May 20, 2021