ISSN 2996-8215
International Journal of Cardiology | Vol. 10, No. 8, August 2019 | pp. 57–64
DOI: 10.46882/2019/IJC/000125
Original Research Article
Independent Prognostic Significance of Left Atrial Reservoir Strain for Predicting Late Atrial Fibrillation Recurrence Post-Cryoballoon Isolation
Sven Lindstrom¹, Ingrid Johansson¹, Anders Nielsen²
¹Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
²Department of Clinical Physiology, Aarhus University Hospital, Aarhus, Denmark
Abstract:
Cryoballoon catheter ablation achieves high rates of pulmonary vein isolation (PVI), but late arrhythmia recurrence remains a common limitation. Standard anatomical metrics like left atrial (LA) diameter fail to capture early compliance changes secondary to tissue remodeling. Left atrial reservoir strain (LA-RS), measured via speckle-tracking echocardiography, offers a non-invasive index of functional wall integrity. This study evaluated whether baseline LA-RS independently predicts late atrial fibrillation (AF) recurrence post-cryoballoon intervention. We prospectively enrolled 160 patients with symptomatic paroxysmal AF undergoing a first-time cryoballoon PVI. Transthoracic deformation imaging was performed before the procedure to quantify LA-RS across apical views. The primary endpoint was any documented recurrence of atrial tachyarrhythmia lasting longer than 30 seconds after a 90-day blanking period, tracked over 36 months. Late arrhythmia recurrence occurred in 54 patients (33.8%) during the follow-up period. Baseline mean LA-RS was significantly lower in patients who experienced recurrence than in those who maintained sinus rhythm (18.2% ± 3.1% vs. 27.4% ± 4.2%, p < 0.001). Multivariable Cox proportional hazards analysis confirmed that an absolute baseline LA-RS less than 20% was a potent, independent predictor of late AF recurrence (hazard ratio: 2.34, 95% CI: 1.41–3.88, p = 0.001). Conversely, indexed left atrial volume metrics lost independent significance in the fully adjusted model. Left atrial reservoir strain is independently associated with late arrhythmia recurrence after cryoballoon ablation, providing superior prognostic data over standard volumetric criteria.
Keywords: Atrial fibrillation, Cryoballoon ablation, Speckle-tracking echocardiography, Left atrial strain, Recurrence, Structural remodeling
Received: May 12, 2019; Revised: June 25, 2019; Accepted: July 14, 2019; Published: August 20, 2019
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