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Baseline left atrial strain imaging assessment predicts arrhythmia recurrence in patients with paroxysmal or persistent atrial fibrillation undergoing catheter ablation
Session:
Posters - C. Arrhythmias and Device Therapy
Speaker:
Pedro Brás
Congress:
CPC 2021
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.2 Atrial Fibrillation - Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Pedro Garcia Brás; Pedro Silva Cunha; Ana Galrinho; Guilherme Portugal; Bruno Valente; Pedro Rio; Ana Teresa Timóteo; Madalena Coutinho Cruz; Margarida Paulo; Ana Sofia Delgado; Rui Cruz Ferreira; Mário Oliveira; Luisa Moura Branco
Abstract
<p><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><span style="font-size:12.0pt">Introduction: Left atrial (LA) strain imaging by echocardiography (TTE) is a promising tool in the evaluation of LA mechanical function. The aim of this study was to compare LA structure and strain imaging between paroxysmal (PAF) and persistent AF (PersAF) and evaluate rates of AF recurrence post-index catheter ablation. Methods:</span> <span style="font-size:12.0pt">Analysis of consecutive patients with symptomatic PAF and PersAF who underwent a first AF catheter ablation with at least 12-month follow-up and had performed TTE in our centre prior to the procedure. LA strain parameters were assessed by 2D speckle-tracking at baseline. LA diameter index (LAVi), LA phasic strain: reservoir (LASr), conduit (LAScd) and contraction phases (LASct) and respective phases’ strain rate (SR), as well as integrated backscatter (IBS) were analysed. AF recurrence was documented with 12-lead ECG, 24h Holter monitoring, external loop recorder or pacemaker analysis in a 12-month follow-up period. Results: 78 patients (31% PersAF vs. 69% PAF) who underwent pulmonary vein isolation (PVI) were studied (cryoballoon ablation [CBA] in 53% and radiofrequency ablation in 47%). There was no significant difference between groups (PersAF and PAF) regarding mean age (60±10 vs. 59±12 years, p=0.664), gender (male 67% vs. 65%, p=0.543), structural heart disease (50% vs. 33%, p=0.132) or PVI modality (CBA 46% vs. 55%, p=0.469). Patients with PersAF had a significantly higher LAVi (46±15 mL/m2 vs. 36±13 mL/m2 p=0.004), reduced LA ejection fraction (19±15% vs. 49±19%, p<0.001) and impaired LASr (9.2±4.9% vs. 23.9±9.3%, p<0.001), as well as reservoir SR (0.58±0.25 s<sup>-1</sup> vs. 1.08±0.40 s<sup>-1</sup>, p<0.001). There was no significant difference between groups regarding the conduit phase strain: LAScd (-9.0±4.9% vs. -11.3±7.3%</span>, <span style="font-size:12.0pt">p= 0.108), conduit SR (-0.92±0.61 s<sup>-1</sup> vs. -0.94±0.39 s<sup>-1</sup>, p=0.894) or IBS (116.6±36.1 dB vs. 106.6±21.5 dB, p=0.134). Patients with PAF in sinus rhythm during TTE showed a LASct of 12.5±5.6% and contractile SR of -1.37±0.6 s<sup>-1</sup>. The AF burden at 3-month post-PVI external loop recorder was 0% in 50% PersAF patients vs. 79% PAF; 1-99% in 35% vs. 21% and 99-100% in 15% vs. 0%, p=0.008. During follow-up there was a 28% (22 patients) AF recurrence rate (PersAF 50% vs. PAF 20%, adjusted HR 3.44 [95% CI 1.44-7.69], p=0.005). (Figure 1 – Kaplan Meier analysis). In patients with AF recurrence, PersAF showed a significantly inferior baseline LASr (6.44±3.25 vs. 13.85±5.65, p=0.003). Reduced baseline LASr was a significant predictor of AF recurrence both in PAF (adjusted HR 1.29 [95% CI 1.13-1.48], p<0.001) and PersAF (adjusted HR 1.22 [95% CI 1.02-1.47], p=0.028). Conclusion: Patients with PersAF showed increased LA volume, reduced LA ejection fraction and reservoir phase strain parameters at baseline, as well as superior AF burden and 12-month recurrence rate after PVI vs. PAF. Reduced baseline LASr was a significant predictor of AF recurrence both in PAF and PersAF.</span></span></span></p>
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