Right atrial myocardial deformation by two-dimensional speckle tracking echocardiography predicts recurrence in paroxysmal atrial fibrillation
Atrial fibrillation (AF) is a bi-atrial disease yet little attention has been given to right heart function in AF. We propose that the assessment of right atrial (RA) and right ventricular function (RV) using two-dimensional speckle tracking echocardiography (2D-STE) could be valuable in predicting AF recurrence in patients with paroxysmal AF (PAF).
Thirty patients with PAF were prospectively recruited from a dedicated AF clinic. Right atrial size, volume, and area and RV dimensions were analyzed along with RA and RV strain derived from 2D-STE at baseline and at 3 and 12 months.
Higher RA booster strain independently predicted sinus rhythm (SR) maintenance for up to 1 year (P = 0.001). RV strain was impaired in patients with recurrent AF compared to those in SR (P < 0.05) but did not predict AF recurrence. Two-dimensional STE for RA and RV function was simple to perform with excellent reproducibility (adjusted R 2 0.92–0.99).
Two-dimensional STE is useful and highly reproducible in assessing right heart function in AF patients. RA booster strain function was predictive of sinus rhythm maintenance for up to 1 year.
KeywordsAtrial fibrillation Right atrial strain Right ventricular strain Two-dimensional speckle tracking echocardiography
Funding was provided by British Heart Foundation (BHF) (Grant Number PG/08/038/24217).
Compliance with ethical standards
This study on patients with PAF was performed at St George’s University of London and St George’s Hospital, NHS Trust, London, UK
Conflict of interest
The British Heart Foundation (BHF) grant reference number was PG/08/038/24217. The title was “Utility of natriuretic peptides in patients with atrial fibrillation undergoing direct-current cardioversion or those requiring rate-control”. The Principal Investigator and grant holder was Professor A John Camm. The BHF grant only covered the peptides in atrial fibrillation. However, we have reported in our manuscript a correlation between peptides and echocardiographic parameters. Dr. Samir Kanti Saha performed the statistical analysis and created the first draft of the manuscript in conjunction with MG and AK. Professor A John Camm was a BHF Professor until June 2012. The grant started on the 01/07/2008. Dr. Malini Govindan was funded by this BHF grant as a Research Fellow in order to complete her PhD thesis. Malini Govindan, Anatoli Kiotsekoglou, Samir Kanti Saha, and John Camm declare that they have no conflicts of interest.
The study was approved by the Local Ethics Committee at St George’s University of London, London, UK and informed consent was obtained from eligible patients.
Human and animal rights statement
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
- 6.Lai LP, Su MJ, Lin JL, et al. Down-regulation of L-type calcium channel and sarcoplasmic reticular Ca(2+)-ATPase mRNA in human atrial fibrillation without significant change in the mRNA of ryanodine receptor, calsequestrin and phospholamban: an insight into the mechanism of atrial electrical remodeling. J Am Coll Cardiol. 1999;33(5):1231–7.CrossRefPubMedGoogle Scholar
- 8.Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography. J Am Soc Echocardiogr. 2005;18(12):1440–63.CrossRefPubMedGoogle Scholar
- 9.Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23(7):685–713.CrossRefPubMedGoogle Scholar
- 12.Di SG, Caso P, Lo PR, et al. Atrial myocardial deformation properties predict maintenance of sinus rhythm after external cardioversion of recent-onset lone atrial fibrillation: a color Doppler myocardial imaging and transthoracic and transesophageal echocardiographic study. Circulation. 2005;112(3):387–95.CrossRefGoogle Scholar
- 29.Bertaglia E, Stabile G, Senatore G, et al. A clinical and health-economic evaluation of pulmonary vein encircling ablation compared with antiarrhythmic drug treatment in patients with persistent atrial fibrillation (Catheter Ablation for the Cure of Atrial Fibrillation-2 study). Europace. 2007;9(3):182–5.CrossRefPubMedGoogle Scholar
- 31.van Brakel TJ, van der Krieken T, Westra SW, van der Laak JA, Smeets JL, van Swieten HA. Fibrosis and electrophysiological characteristics of the atrial appendage in patients with atrial fibrillation and structural heart disease. J Interv Card Electrophysiol. 2013;38(2):85–93.CrossRefPubMedGoogle Scholar
- 41.Saha SK, Söderberg S, Lindqvist P. Association of right atrial mechanics with hemodynamics and physical capacity in patients with idiopathic pulmonary arterial hypertension: insight from a single-center cohort in northern Sweden. Echocardiography. 2016;33(1):46–56. doi: 10.1111/echo.12993 (Epub 2015 Jun 11).CrossRefPubMedGoogle Scholar