Left atrial strain analysis in relation to heart failure in patients undergoing first atrial fibrillation ablation

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 improves mortality in HF patients. Advanced atrial myopathy (AM) is likely to be related with recurrence after AF ablation. Baseline left atrial reservoir strain (LArS) is suggested to describe the degree of AM and can predict recurrences after AF ablation.

Depending on the stage of HF, different degrees of AM are related with alteration of LArS.

Patients with symptomatic AF undergoing first AF ablation from 2020 - 2024 were included. Inclusion criteria were as following: Ablation performed with a single-shot device (PFA or cryoballoon ablation), pre- & post-interventional transthoracic echocardiography (TTE) in continuous sinus rhythm of adequate image quality, follow-up information about post-procedural outcome. Clinical as well as procedural parameters were collected and retrospectively analyzed. LA strain analysis was performed for pre- & post-interventional TTE.

Of 398 patients undergoing first AF ablation a single-shot device was used in 263 patients. 98 patients fulfilled TTE criteria and in 84 patients follow-up information was available.

Pre-interventional LArS was lower in patients experiencing recurrence of AF after ablation (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-ablation: HF: 20.04% vs. non-HF: 22.75%, p=0.019; post-ablation: HF: 19.34% vs. non-HF: 23.16%, p=0.001).

LArS was not affected significantly by AF ablation in non-HF patients (Pre-ablation: 22.75% vs. post-ablation: 23.16%, p=0.31). For HF patients in contrast, LArS was significantly reduced after ablation in comparison to pre-interventional strain (Pre-ablation: 20.04% vs. post-ablation: 19.34%, p=0.01).

Left atrial reservoir strain was lower in patients with heart failure compared to those without heart failure and in those with arrhythmia recurrence after AF ablation. After ablation, left atrial reservoir strain was reduced in heart failure patients, but not in those without heart failure. Larger studies are needed to analyze the relevance of left atrial reservoir strain analysis in correlation to AF recurrences and to atrial myopathy.