https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Essen Klinik für Kardiologie und Angiologie Essen, Deutschland
Background:
Atrial fibrillation (AF) is the most common arrhythmia in heart failure (HF) patients. and HF is the most common cause of death in patients with AF. Rhythm control with AF catheter ablation (CA) improves mortality in HF patients. Advanced atrial myopathy (AM) is likely to be related with recurrence after CA. Baseline left atrial reservoir strain (LArS) is suggested to describe the degree of AM and can predict recurrences after CA.
Hypothesis:
Depending on the stage of HF, different degrees of AM correlate with alteration of LArS.
Methods:
Patients with symptomatic AF undergoing first CA from 2020 - 2024 were included. Inclusion criteria were as following: First CA performed with single-shot device (PFA or cryoballoon ablation), pre- & post-interventional transthoracic echocardiography (TTE) in continuous sinus rhythm (SR) of adequate image quality, follow-up information about post-procedural outcome after the blanking period. Clinical as well as procedural parameters were collected and retrospectively analyzed. LA strain analysis was performed for pre- & post-interventional TTE.
Results:
Of 398 patients undergoing first CA a single-shot device was used in 263 patients. TTE criteria were fulfilled by 98 patients and follow-up information was available for 84 patients.
Pre-interventional LArS was lower in patients experiencing recurrence of AF after CA (HF: AF-recurrence: 17.78% vs. no recurrence: 21.2%, p=0.01; Non-HF: AF-recurrence: 19.37% vs. no recurrence: 23.81%, p=0.022).
Pre- & post-interventional LArS was lower in HF patients compared to non-HF patients (Pre-CA: HF: 20.04% vs. non-HF: 22.75%, p=0.019; post-CA: HF: 19.34% vs. non-HF: 23.16%, p=0.001)
LArS was not affected significantly by CA in non-HF patients (Pre-CA: 22.75% vs. post-CA: 23.16%, p=0.31). For HF patients in contrast, LArS was significantly reduced after CA in comparison to pre-interventional strain (Pre-CA: 20.04% vs. post-CA: 19.34%, p=0.01).
Conclusion:
Left atrial reservoir strain was lower in patients with recurrence after AF ablation and in patients with heart failure compared to those without heart failure. After ablation, left atrial reservoir strain was reduced in heart failure patients, but not in those without heart failure. Further studies are needed to analyze the relevance of left atrial reservoir strain in correlation to AF recurrences and to atrial myopathy.