Differences between right and left atrial strain and geometric parameters in prediction of ablation outcomes for paroxysmal atrial fibrillation
S Chu, Y N Pan, F F Liu, J Jiang, J ZhouAbstract
Background
Left atrial functional and geometric alteration before ablation procedures has long been associated with recurrence of atrial fibrillation (AF). Right atrial parameters have been less characterized.
Purpose
To explore the potential difference in value between right and left atrial strain and geometric parameters in the prediction of ablation outcomes for paroxysmal AF.
Methods
Paroxysmal AF patients receiving catheter ablation (radiofrequency or cryoballoon) for pulmonary vein isolation between 2014 and 2024 and followed up in a tertiary center were retrospectively reviewed. All participants underwent transthoracic echocardiography before the index ablation, and off-line two-dimensional speckle-tracking analysis was collected. Multivariate Logistic regression analysis was used to identify right and left atrial strain and geometric parameters in the prediction of 3-month and 12-month recurrence of AF.
Results
A total of 676 patients with paroxysmal AF who underwent ablation and completed 3-month and 12-month follow-up were analyzed, among whom 230 (34.0%) were females, and the average age was 62±10 years. Early (3-month) and long-term (12-month) relapses were observed in 255 (37.7%) and 210 (31.1%) cases, respectively. Left atrial end-systolic volume (LAESV) and left atrial ejection fraction (LAEF), reservoir left atrial strain (LA-Sr), and right atrial strain (RA-Sr) were associated with short-term (3-month) AF recurrence, while LA-Sr was an independent predictor of 3-month AF recurrence [OR(95%CI): 0.97(0.96-0.99)，p=0.001]. Right atrial end-diastolic volume (RAEDV), RA-Sr, as well as LAESV, LAV coupling index [left atrial end-diastolic volume (LAEDV)/ left ventricular end-diastolic volume (LVEDV)], and RA-LV coupling index (RAEDV/LVEDV) were associated with long-term (12-month) AF recurrence. RA-LV coupling index was an independent predictor of 12-month AF recurrence [OR(95%CI): 4.33(1.68-11.17) ，p=0.002].
Conclusions
Early recurrence of AF after ablation showed a closer relationship to LA dysfunction. In contrast, more significant RA enlargement and functional deterioration suggest advanced bi-atrial remodeling and provide additional value in the prediction of long-term efficacy of AF ablation.Logistic regression for AF recurrence