https://doi.org/10.1007/s00392-024-02526-y
1Universitätsklinikum Essen Klinik für Kardiologie und Angiologie Essen, Deutschland
Background:
In symptomatic atrial fibrillation (AF) pulmonary vein isolation (PVI) has become the cornerstone therapy for rhythm control. Besides thermal approaches, such as cryoballoon ablation (CBA), a non-thermal ablation modality with high selectivity for cardiomyocytes – pulsed field ablation (PFA) – has been introduced. Left atrial reservoir strain (LArS) has been suggested to predict recurrences of AF after PVI using radiofrequency ablation. However, the effect of non-thermal PVI on LArS and its relation with AF-recurrence have not been shown yet.
Hypothesis:
LA remodeling, represented by the surrogate marker LArS, varies depending on the used AF ablation mode.
Methods:
Patients with symptomatic AF undergoing their first PVI between 2020 and 2023 were retrospectively analyzed. Clinical and procedural parameters were collected. Inclusion criteria were a pre- & post-interventional transthoracic echocardiography (TTE) in continuous sinus rhythm and adequate imaging quality of the LA. Echocardiographic parameters such as LArS were measured pre & post PVI. AF-recurrence during follow-up was correlated with echocardiographic LA remodeling parameters.
Results:
Of 267 patients undergoing PVI, 75 patients (69% male, median age 66 [63-68] years) fulfilled inclusion criteria. Baseline characteristics of patients undergoing PFA (63%) or CBA (37%) were similar.
Before PVI, LArS was similar for PFA (18.61 ± 4.1%) and CBA patients (19.23 ± 4.39%, P=0.57).
After PVI, LArS did not change significantly compared to the values before (pre-PVI: 18.85 ± 4.2% vs. post-PVI: 18.29 ± 4.92%, P=0.89), irrespective of the ablation mode (PFA pre: 18.61 ± 4.1% vs. PFA post: 18.15 ± 5.15%, P=0.84; CBA pre: 19.23 ± 4.39% vs. CBA post: 18.54 ± 4.59%, P=0.92).
After a median of 118 ± 21 days, 25 patients (33%) experienced AF recurrence (PFA: 30%, CBA: 39%).
LArS pre-PVI was lower in patients with (17.1 ± 3.66%) versus those without AF-recurrence (19.67 ± 4.2%, P=0.02). When differentiating the ablation mode, only patients with CBA-PVI and AF-recurrence had a low LArS pre-PVI (CBA: AF-recurrence: 15.8 ± 4.15% vs. no recurrence: 20.84 ± 3.58%, P=0.005) compared to patients undergoing PFA-PVI (PFA: AF-recurrence: 17.9 ± 3.22% vs. no recurrence: 18.92 ± 4.46%, P=0.48).
Looking at post-PVI values, LArS values did not significantly differ between AF-recurrence vs. no recurrence (post PVI: AF-recurrence: 18.83 ± 4.91% vs. no recurrence: 17.1 ± 4.85%, P=0.17). After PFA, post-interventional LArS did not significantly differ between AF-recurrence & no recurrence group (PFA post: AF-recurrence: 18.4 ± 4.17% vs. no recurrence: 18.05 ± 5.52%, P=0.84). However, when comparing post-PVI LArS values after CBA, patients with AF recurrence had lower LArS values (CBA post: AF-recurrence: 15.53 ± 5.34% vs. no recurrence: 20.42 ± 2.85%, P=0.02).
Conclusions:
This hypothesis generating study confirms that potential influences of PFA- and CBA-ablation on LA remodeling can be quantified by LA strain analysis. LArS appears to be affected by CBA and to correlate with AF-recurrence. In contrast, LArS after PFA ablation appears to be unaffected. Patients with lower LArS pre PVI had more AF-recurrences irrespective of the ablation mode.