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The value of serial echocardiography in risk assessment of patients with paroxysmal atrial fibrillation

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Abstract

Progression from paroxysmal to persistent atrial fibrillation (AF) is associated with increased morbidity and mortality. We examined the association of left atrial (LA) remodeling by serial echocardiography, and AF progression over an extended follow-up period. Two-hundred ninety patients (mean age 61  ±  11 years, 73% male) who underwent transthoracic echocardiography performed at first presentation for non-valvular paroxysmal AF (PAF) and repeat echocardiogram 1-year later, were followed for progression to persistent AF. LA and left ventricular (LV) dimensions, volumes, LA reservoir, conduit and booster pump strains, LV global longitudinal systolic strain (GLS) assessed by 2D speckle tracking, and PA-TDI (time delay between electrical and mechanical LA activation– reflecting the extent of LA fibrosis) were compared on serial echocardiography. Sixty-nine (24%) patients developed persistent AF over a mean follow-up period of 6.3 years. At baseline, patients with subsequent persistent AF had larger LA dimensions (46 mm vs. 42 mm, p < 0.001), indexed LA volumes (41 ml/m2 vs. 34 ml/m2, p < 0.001), lower LA reservoir and conduit strain (17.6% vs. 27.6%, p < 0.001; 10.5% vs. 16.3%, p < 0.001; respectively) and longer PA-TDI (155 ms vs. 132 ms, p < 0.001) compared to the PAF group. Patients with subsequent persistent AF showed over time significant enlargement in LA volumes (from 37.7 ml/m2 to 42.4 ml/m2, p < 0.001), lengthening of PA-TDI (from 142.2 ms to 162.2 ms, p = 0.002), and decline in LA reservoir function (from 21.9% to 18.1%, p = 0.024) after adjusting for age, gender, diabetes and LV GLS. There were no changes in LA diameter, LA conduit or booster pump function. Conversely, the PAF group showed no decline in LA function. Patients who developed persistent AF had larger LA size and impaired LA function and atrial conduction times at baseline, compared to patients who remained PAF. Over the 1-year time course of serial echocardiographic evaluation, there was progression of LA remodeling in patients who subsequently developed persistent AF, but not in patients who remained in PAF.

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Abbreviations

2D:

Two-dimensional

AF:

Atrial fibrillation

CHA2DS2-VASc:

Acronym for congestive heart failure, hypertension, age ≥ 75 (doubled), diabetes, stroke (doubled), vascular disease, age 65–74, and sex category (female)]

ECG:

Electrocardiogram

GLS:

Global longitudinal strain

IQR:

Interquartile range

LA:

Left atrial

LV:

Left ventricular

NYHA:

New York Heart Association

PAF:

Paroxysmal atrial fibrillation

PA-TDI:

Time interval between left atrial electrical and mechanical activation of the left atrium

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Authors and Affiliations

  1. Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands

    Melissa Leung, Philippe J. van Rosendael, Pieter van der Bijl, Madelien V. Regeer, Suzanne E. van Wijngaarden, Victoria Delgado, Nina Ajmone Marsan & Jeroen J. Bax

  2. Department of Cardiology, Liverpool Hospital, Ingham Institute for Applied Medical Research, The University of New South Wales, Sydney, Australia

    Melissa Leung & Dominic Y. Leung

  3. The University of New South Wales, Sydney, Australia

    Arnold C. T. Ng

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Contributions

ML: Conception and design of the study; collection, analysis and interpretation of data; drafting of the manuscript; final approval of the manuscript. PJvanR Conception and design of the study; collection, analysis and interpretation of data; final approval of the manuscript. MVR Collection, analysis and interpretation of data; final approval of the manuscript. SE van W Collection, analysis and interpretation of data; final approval of the manuscript. NAM Conception and design of the study; collection, analysis and interpretation of data; final approval of the manuscript. DYL Conception and design of the study; drafting of the manuscript; final approval of the manuscript. VD Conception and design of the study; collection, analysis and interpretation of data; drafting of the manuscript; final approval of the manuscript. A CT N Interpretation of data; drafting of the manuscript; final approval of the manuscript. JJB Conception and design of the study; collection, analysis and interpretation of data; drafting of the manuscript; final approval of the manuscript.

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Correspondence to Melissa Leung.

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Conflict of interest

The Department of Cardiology, LUMC, received research grants from Medtronic, Biotronik, Boston Scientific and Edwards Lifesciences. VD received speaker fees from Abbott Vascular. JJB received speaker fees from Abbott and Edwards Lifesciences.

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The Institutional Review Board approved this retrospective analysis of clinically acquired data and waived the need for patient written informed consent.

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Leung, M., van Rosendael, P.J., van der Bijl, P. et al. The value of serial echocardiography in risk assessment of patients with paroxysmal atrial fibrillation. Int J Cardiovasc Imaging 40, 499–508 (2024). https://doi.org/10.1007/s10554-023-03014-6

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