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Evaluation of left atrial strain imaging and integrated backscatter as predictors of recurrence in patients with paroxysmal, persistent, and long-standing persistent atrial fibrillation undergoing catheter ablation

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Abstract

Background

Impaired left atrial (LA) strain predicts atrial fibrillation (AF) recurrence after catheter ablation (CA), but currently there is no cut-off to guide patient selection for CA. Integrated backscatter (IBS) is a promising tool for noninvasive quantification of myocardial fibrosis.

The aim of this study was to compare LA strain and IBS between paroxysmal, persistent, and long-standing persistent AF and evaluate their association with AF recurrence after CA.

Methods

Analysis of consecutive patients with symptomatic paroxysmal and persistent AF who underwent CA. LA phasic strain, strain rate and IBS were assessed by two-dimensional speckle-tracking at baseline.

Results

We analyzed 78 patients, 31% with persistent AF (46% long-standing AF), 65% male, mean age 59 ± 14 years, who underwent CA and were followed-up for 12 months. AF recurrence occurred in 22 (28%) patients. LA phasic strain parameters were significantly impaired in patients with AF recurrence and were independent predictors of AF recurrence in a multivariable analysis. LA reservoir strain (LASr) < 18% predicted AF recurrence with 86% sensitivity and 71% specificity, with a higher predictive power compared to LA volume index (LAVI). LASr < 22% in paroxysmal AF and LASr < 12% in persistent AF correlated with AF recurrence. Increased IBS was a predictor of AF recurrence in patients with paroxysmal AF.

Conclusion

LA phasic strain parameters were predictors of AF recurrence after CA, independently of LAVI and AF subtype. LASr < 18% showed a higher predictive power compared to LAVI. Further studies are needed to investigate the role of IBS as a predictor of AF recurrence.

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Acknowledgements

The authors would like to thank the Electrophysiology and Echocardiography teams of the Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central for their invaluable input in improving the manuscript.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Author notes

  1. Pedro Garcia Brás and Pedro Silva Cunha contributed equally to this work.

Authors and Affiliations

  1. Cardiology Department, Santa Marta Hospital, Central Lisbon Hospital University Center, Rua de Santa Marta, n.50, 1169-024, Lisbon, Portugal

    Pedro Garcia Brás, Pedro Silva Cunha, Ana Teresa Timóteo, Guilherme Portugal, Ana Galrinho, Madalena Coutinho Cruz, Bruno Valente, Pedro Rio, Ana Sofia Delgado, Margarida Paulo, Manuel Brás, Rui Cruz Ferreira, Mário Martins Oliveira & Luísa Moura Branco

  2. NOVA Medical School, Faculdade de Ciências Médicas (NMS|FCM), Lisbon, Portugal

    Ana Teresa Timóteo

  3. Department of Physiology, NOVA Medical School|Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Portugal

    Sérgio Laranjo & Mário Martins Oliveira

  4. Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal

    Sérgio Laranjo

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Contributions

Original study idea by Pedro Garcia Brás, Pedro Silva Cunha and Luísa Moura Branco. All authors contributed to the study conception and design. Data collection and analysis were performed by Pedro Garcia Brás and Pedro Silva Cunha. Echocardiograms were performed by Ana Galrinho and Luísa Moura Branco. Two-dimensional speckle-tracking data processing was reviewed by Pedro Garcia Brás and Pedro Rio. Catheter ablations of atrial fibrillation were performed by Pedro Silva Cunha, Guilherme Portugal, Sérgio Laranjo, Bruno Valente, Ana Sofia Delgado, Margarida Paulo, Manuel Brás and Mário Martins Oliveira. The first draft of the manuscript was written by Pedro Garcia Brás and Pedro Silva Cunha and all authors commented on previous versions of the manuscript. Critical revisions were performed by Pedro Silva Cunha, Ana Teresa Timóteo, Madalena Coutinho Cruz, Mário Martins Oliveira and Luísa Moura Branco. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Pedro Garcia Brás.

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Ethical disclosures

The authors declare that no experiments were performed on humans or animals for this study. Ethical approval was waived by the local Ethics Committee (Centro Hospitalar Universitário Lisboa Central) in view of the retrospective nature of the study (conducted on already available digital data, obtained for clinical purposes) and all the procedures being performed were part of the routine care.

Consent to participate and publish

The study was conducted under the Declaration of Helsinki and each participant provided informed consent before undergoing echocardiography and AF ablation (consent to participate and consent to publish).

Confidentiality of data

The authors declare that they have followed the protocols of their work center on the publication of patient data. The dataset generated during this study is currently not publicly shared as it contains detailed individual patient data, which would compromise patient privacy. The generated dataset is currently accessible to the Santa Marta Hospital, Centro Universitário Hospitalar de Lisboa Central’s Electrophysiology Team.

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The authors declare that no patient data appear in this article.

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The authors have no relevant financial or non-financial interests to disclose, including no recent, present or anticipated employment by any organization that may gain or lose financially through publication of this manuscript.

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Brás, P.G., Cunha, P.S., Timóteo, A.T. et al. Evaluation of left atrial strain imaging and integrated backscatter as predictors of recurrence in patients with paroxysmal, persistent, and long-standing persistent atrial fibrillation undergoing catheter ablation. J Interv Card Electrophysiol 67, 479–492 (2024). https://doi.org/10.1007/s10840-023-01602-z

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