Left atrial Strain as a predictor of atrial fibrillation recurrence after catheter ablation
Authors: Blyalova D , Abdrakhmanov A S , Baydurin S A , Nuralinov ОМ , Balmukhamedova Z H A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Atrial fibrillation (AF) is one of the most common cardiac arrhythmias. In arrhythmology, catheter ablation methods are successfully used in the treatment of AF.

Objective
To assess the significance of left atrial (LA) longitudinal deformity in predicting AF recurrence after catheter ablation.
Research material and methods: The study was carried out on the basis of NJSC "National Scientific Cardiac Surgery Center" in the Department of Interventional Arrhythmology. The study included 150 patients, whose average age was 62.4 ± 7.47 years. All patients underwent catheter ablation of the pulmonary veins. Patients were divided into 2 groups depending on the effectiveness of ablation: with recurrent AF (47) and patients who maintained sinus rhythm for 12 months (103). Heart parameters were assessed in two-dimensional (2D) conventional and speckle-tracking echocardiography of the left atrium (LA).

Results
According to the results of Speckle-tracking echocardiography, the peak values of longitudinal and contractile LA deformity were significantly lower in the group where AF relapsed soon and amounted to -17.4319±0.52 and -22.9194±1.13, respectively (p&lt;0, 0001). According to the results of an echocardiographic study, the LA volume was 100.10±28.5 ml in the first group and 74.85±14.44 ml in the 2nd group (p&lt;0.01), which exceeds normal values. Statistical difference revealed (p&lt;0.01), such indicators as the indexed volume of the LA and its area, which amounted to 47.27±9.21 ml/m²; 38.13±6.85 ml/m²; and 26.61±3.37 cm²; 22.72±3.12 cm², respectively. LVML in group 1 was 225.3±44.1, in group 2 160.29±40.61 (p&lt;0.01), LVMI was 112±19.25 and 83.30±20.17 (p&lt;0.01). Correlation analysis revealed a positive relationship between AF recurrence and LA area (r=0.599; p&lt;0.01), longitudinal LA deformity (r=-0.804), RA area (r=0.479; p&lt;0.01), LVMI (r=0.557; p&lt;0.01), LVMI (r=0.367; p&lt;0.01), LV EDR (r=0.381; p&lt;0.01), LV ESR (r=0.375; p&lt;0 .01). Analysis of the ROC curve of the relationship between relapse and LA volume showed that the area under the ROC curve was 0.786 ± 0.045 with 95% CI: 0.679-0.858. Assessing the relationship between AF recurrence and LA area, the area under the ROC curve was 0.783 ± 0.043 with 95% CI: 0.699-0.867. The threshold value of the volume and area of the LA at the cut-off point is 81.5 (sensitivity and specificity were 70.2% and 66%%) and 24.5 (sensitivity and specificity were 68.1% and 68.9%) ( p&lt;0.001).

Conclusion
Speckle tracking echocardiography is a valuable tool for evaluating left atrial function in patients with AF and may be of diagnostic value for the prognostic detection of AF recurrence in patients after catheter ablation. Evaluation of echocardiographic parameters in patients with AF revealed that an increase in such parameters as the volume and area of the left and right atrium, LVMI, MMLV, LV EDD, LV ESD has a moderate positive correlation with recurrent AF.