Background:
Atrial fibrillation (AF) is the most common arrhythmia in heart failure (HF) patients. Likewise, in AF patients HF is one of the most common causes of death. Latest data indicate that rhythm control via AF ablation improves survival of HF patients.
Reduced baseline left atrial reservoir strain (LArS) is suggested to be a surrogate parameter for LA function and to predict recurrence after AF ablation. Whether there is an interaction between HF and LA function, as resembled by LArS, remains to be determined.
Hypothesis:
LArS correlates with HF-type and is influenced by AF ablation.
Methods:
Patients with symptomatic AF undergoing first catheter ablation from 2020 - 2024 were included. Inclusion criteria were as following: First AF ablation performed with a single-shot device, pre- and post-interventional transthoracic echocardiography (TTE) in continuous sinus rhythm (SR) of adequate image quality and follow-up information about post-procedural outcome after blanking period. LA strain analysis was performed for pre- and post-interventional TTE. Clinical as well as procedural parameters were collected and retrospectively analyzed. HF-type & procedural outcome after AF ablation were correlated with LArS.
Results:
Of 398 patients undergoing first AF ablation a single-shot device was used in 263 patients. TTE criteria were fulfilled by 98 patients and follow-up was complete for 94 patients, which underwent further analysis.
Among the study population, 28 patients had no HF (30%), 47 patients presented with HFpEF (50%) and 19 patients had reduced left ventricular ejection fraction (LVEF) (20%) - comprising 13 patients with HFmrEF (14%) and 6 patients with HFrEF (6%).
At baseline, mean LArS-pre was 22.69 ± 4.04% for no-HF patients, 20.31 ± 4.57% for HFpEF patients, 19.6 ± 6% for HFmrEF patients and 14.81 ± 5.03% for HFrEF patients (ANOVA, p=0.002). Univariate regression analysis suggested an association of LArS-pre with HF-type (OR = 0.86, 95% CI: 0.79-0.93; p<0.001).
A similar distribution for the HF-type occurred for post-interventional LArS: Mean LArS-post was 23.1 ± 3.83% for no-HF patients, 19.71 ± 4.69% for HFpEF patients, 18.66 ± 5.51% for HFmrEF patients and 14.79 ± 3.9% for HFrEF patients (ANOVA, p<0.001). LArS-post was also significantly associated with HF-type (OR = 0.823, 95% CI: 0.75-0.9; p<0.001), suggesting that a lower LArS correlates with a more severe HF-type.
Further, patients with (n=30, 32%) and without AF recurrence (n=64, 68%) after ablation were analyzed:
In the AF recurrence subgroup, mean LArS-pre was 20.82 ± 4.32% for no-HF patients, 18.71 ± 3.24% for HFpEF patients and 16.15 ± 3.87% for patients with reduced LVEF (ANOVA, p=0.1). Mean post-interventional LArS-post was 21.59 ± 5.42% for no-HF patients, 18.25 ± 2.25% for HFpEF patients & 14.21 ± 1.99% for patients with reduced LVEF (ANOVA, p=0.004).
In the no AF recurrence subgroup, mean baseline LArS-pre was 23.43 ± 3,78% for no-HF patients, 21.31 ± 5.03% for HFpEF patients and 18.61 ± 6.49% for patients with reduced LVEF (ANOVA, p=0.026). Mean post-interventional LArS-post, was 23.66 ± 2.97% for no-HF patients, 20.61 ± 5.56% for HFpEF patients & 18.3 ± 5.59% for patients with reduced LVEF (ANOVA, p=0.008).
Conclusion:
In patients undergoing first AF ablation pre- and postprocedural LArS correlates with HF-type, independent of the post-procedural outcome. Larger studies are needed to confirm this finding.
