Lower values of PALS are associated with an increased risk of AF recurrence after RFA .
PALS provides prognostic value in clinical practice
The usefulness of peak atrial longitudinal strain ( PALS ) in identifying patients at high risk of atrial fibrillation ( AF ) recurrence after radiofrequency ablation ( RFA )  has been investigated in several small AF population s. The aim of this systematic review and meta- analysis was to investigate whether PALS predicts recurrence of AF after RFA treatment .
Left atrial deformation imaging with ultrasound based two-dimensional speckle-tracking predicts the rate of recurrence of paroxysmal and persistent atrial fibrillation after successful ablation procedures.
OBJECTIVE Since predictors of recurrence of atrial fibrillation ( AF ) after ablation procedures are poorly defined , this prospect i ve study was conducted to assess the value of left atrial ( LA ) deformation imaging with two-dimensional speckle-tracking ( 2D-ST ) to predict AF recurrences after successful ablation procedures . METHODS AND RESULTS One hundred and three consecutive patients ( age 58.1 ± 16.6 years , 72.8 % male ) with AF ( 76 paroxysmal , 27 persistent ) and 30 matched controls underwent transthoracic echocardiography and 2D-ST-LA-deformation analysis with assessment of LA-radial and LA-longitudinal strain ( Sr , Sl ) , and velocities derived from the apical 4- and 2-chamber views ( 4CV , 2CV ) . AF recurrence was assessed during 6 months of follow-up . For determination of AF-related LA changes , AF patients were compared to controls and patients with AF recurrences after ablation procedures ( n = 30 , 29.1 % ) were compared with patients who maintained sinus rhythm ( n = 73 , 70.9 % ) . Atrial deformation capabilities were significantly reduced ( P < 0.0005 ) in patients with AF ( 4CVSl 17.8 ± 13.5 % ; 4CVSr 22.3 ± 14.9 % ; 4CV-velocities 2.53 ± 0.97 seconds ) when compared with controls ( 4CVSl 31.3 ± 12.4 % ; 4CVSr 30.3 ± 9.1 % ; 4CV-velocities 3.48 ± 1.01 cm/s ) . Independent predictors for AF recurrence after ablation procedures were 2CV-LA-global-strain ( Sr , P = 0.03 ; Sl , P = 0.003 ) , 4CV-LA-gobal-strain ( Sr , P = 0.03 ; Sl , P = 0.02 ) , and regional LA-septal wall-Sl ( P = 0.008 ) . LA-global-strain parameters were superior to regional LA function analysis for the prediction of AF recurrences , with cutoff values ( cov ) , hazard ratios ( HR ) , positive and negative predictive values ( PPV , NPV ) were : 4CVSl cov , 10.79 % ( HR 27.8 , P < 0.0005 ; PPV 78.8 % , NPV 93.9 % ) , 4CVSr cov , -16.65 % ( HR 24.8 , P < 0.0005 ; PPV 69.4 % , NPV 96.6 % ) , 2CVSl cov , 12.31 % ( HR 22.7 , P < 0.0005 ; PPV 75.8 % , NPV 95.3 % ) , and 2CVSr cov , -14.9 % ( HR 12.9 , P < 0.0005 ; PPV 64.3 % , NPV 93.2 % ) . CONCLUSION Compared with controls , AF itself seems to decrease LA deformation capabilities . The assessment of global LA strain with 2D-ST identifies patients with high risk for AF recurrence after ablation procedures . This imaging technique may help to improve therapeutic guiding for patients with AF
Lower values of PALS are associated with an increased risk of AF recurrence after RFA .
PALS provides prognostic value in clinical practice
The usefulness of peak atrial longitudinal strain ( PALS ) in identifying patients at high risk of atrial fibrillation ( AF ) recurrence after radiofrequency ablation ( RFA )  has been investigated in several small AF population s. The aim of this systematic review and meta- analysis was to investigate whether PALS predicts recurrence of AF after RFA treatment .