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

Purpose: Impaired left atrial (LA) strain by two-dimensional (2D) speckle tracking (STE) is a known predictor of arrhythmia recurrence after catheter ablation (CA) of atrial fibrillation (AF). The aim of this study was to compare LA strain and integrated backscatter (IBS) between paroxysmal, persistent, and long-standing persistent AF and evaluate its association with AF recurrence post-index CA. Methods Analysis of consecutive patients with symptomatic paroxysmal and persistent AF who underwent CA and had performed an echocardiogram in our center prior to CA. LA phasic strain, strain rate and IBS were assessed by 2D STE at baseline. Results We analyzed 78 patients, 31% with persistent AF (46% long-standing AF), 65% male, mean age 59 ± 14 years, who underwent pulmonary vein isolation 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 compared to those without recurrence and were shown to be independent predictors of AF recurrence in a multivariable analysis. LA reservoir strain < 18% predicted AF recurrence with 86% sensitivity and 70% specificity, confirmed in a Kaplan-Meier analysis, with a higher predictive power compared to LA volume index (LAVI). IBS was not associated with AF recurrence. However, patients with paroxysmal AF who experienced AF recurrence showed a significantly higher IBS. Conclusion LA phasic strain parameters were predictors of AF recurrence after CA, independently of LAVI. LA reservoir strain < 18% showed a higher predictive power for AF recurrence compared to LAVI. IBS was not associated with AF recurrence.