Association of Atrial Mechanical Dispersion with Atrial Fibrillation Recurrence Following Catheter Ablation: Results of the ASTRA-AF Pilot Study

Overview

Journal Clin Res Cardiol

Specialty Cardiology & Vascular Diseases

Date 2024 May 21

PMID 38771346

Authors

Dorit Knappe

Julia Vogler

Jessica Weimann

Victor Banas

Sevenai Yildirim

Felix Memenga

Juliana Senftinger

Laura Keil

Djemail Ismaili

Moritz Nies

Andreas Rillig

Stephan Willems

Stefan Blankenberg

Paulus Kirchhof

Andreas Metzner

Christoph Sinning

Affiliations

Soon will be listed here.

Abstract

Aims: For patients with symptomatic drug-refractory atrial fibrillation (AF), catheter ablation to achieve rhythm control is an important therapeutic option. The atrial mechanical dispersion measured as standard deviation of the time to peak strain (SD-TPS) is associated with the risk of AF recurrence following catheter ablation.

Methods: The study cohort prospectively enrolled n = 132 consecutive patients with paroxysmal (n = 88) or persistent AF (n = 44) presenting for de novo pulmonary vein isolation (PVI) and followed for 1 year. We related left atrial (LA) volume, LA ejection fraction, SD-TPS, and global longitudinal strain of the left ventricle and clinical variables (sex, age, and type of AF) to AF recurrence.

Results: Kaplan-Meier curves showed higher AF recurrence rate with an increase of SD-TPS with the calculated cut-off of 38.6 ms. Uni- and multivariable Cox regression analysis could show that SD-TPS had the highest relevance regarding AF recurrence with a HR of 1.05 (95% CI, 1.01; 1.09, p = 0.01) and HR of 1.05 (95% CI, 1.01; 1.09, p = 0.02) per 10 ms increase. In the additional analyses for the model including the clinical variables age, sex, and type of AF with paroxysmal or persisting AF, SD-TPS did only show a trend and after adjusting for covariates, SD-TPS showed a HR of 1.04 (95% CI, 0.99; 1.09, p = 0.09) per 10 ms increase.

Conclusion: Atrial mechanical dispersion was associated with recurrent AF.

References

Modin D, Biering-Sorensen S, Mogelvang R, Alhakak A, Skov Jensen J, Biering-Sorensen T . Prognostic value of left atrial strain in predicting cardiovascular morbidity and mortality in the general population. Eur Heart J Cardiovasc Imaging. 2018; 20(7):804-815. DOI: 10.1093/ehjci/jey181. View

Magnussen C, Niiranen T, Ojeda F, Gianfagna F, Blankenberg S, Njolstad I . Sex Differences and Similarities in Atrial Fibrillation Epidemiology, Risk Factors, and Mortality in Community Cohorts: Results From the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe). Circulation. 2017; 136(17):1588-1597. PMC: 5657474. DOI: 10.1161/CIRCULATIONAHA.117.028981. View

Wazni O, Dandamudi G, Sood N, Hoyt R, Tyler J, Durrani S . Cryoballoon Ablation as Initial Therapy for Atrial Fibrillation. N Engl J Med. 2020; 384(4):316-324. DOI: 10.1056/NEJMoa2029554. View

Kawakami H, Ramkumar S, Pathan F, Wright L, Marwick T . Use of echocardiography to stratify the risk of atrial fibrillation: comparison of left atrial and ventricular strain. Eur Heart J Cardiovasc Imaging. 2019; 21(4):399-407. DOI: 10.1093/ehjci/jez240. View

Kawczynski M, Gilbers M, Van De Walle S, Schalla S, Crijns H, Maessen J . Role of pre-operative transthoracic echocardiography in predicting post-operative atrial fibrillation after cardiac surgery: a systematic review of the literature and meta-analysis. Europace. 2021; 23(11):1731-1743. DOI: 10.1093/europace/euab095. View

Kirchhof P, Camm A, Goette A, Brandes A, Eckardt L, Elvan A . Early Rhythm-Control Therapy in Patients with Atrial Fibrillation. N Engl J Med. 2020; 383(14):1305-1316. DOI: 10.1056/NEJMoa2019422. View

Thomas L, Marwick T, Popescu B, Donal E, Badano L . Left Atrial Structure and Function, and Left Ventricular Diastolic Dysfunction: JACC State-of-the-Art Review. J Am Coll Cardiol. 2019; 73(15):1961-1977. DOI: 10.1016/j.jacc.2019.01.059. View

Hindricks G, Potpara T, Dagres N, Arbelo E, Bax J, Blomstrom-Lundqvist C . 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the.... Eur Heart J. 2020; 42(5):373-498. DOI: 10.1093/eurheartj/ehaa612. View

Bender R, Lange S . Adjusting for multiple testing--when and how?. J Clin Epidemiol. 2001; 54(4):343-9. DOI: 10.1016/s0895-4356(00)00314-0. View

10.

Sarvari S, Haugaa K, Stokke T, Ansari H, Leren I, Hegbom F . Strain echocardiographic assessment of left atrial function predicts recurrence of atrial fibrillation. Eur Heart J Cardiovasc Imaging. 2015; 17(6):660-7. PMC: 4871234. DOI: 10.1093/ehjci/jev185. View

11.

Trivedi S, Campbell T, Stefani L, Thomas L, Kumar S . Strain by speckle tracking echocardiography correlates with electroanatomic scar location and burden in ischaemic cardiomyopathy. Eur Heart J Cardiovasc Imaging. 2021; 22(8):855-865. DOI: 10.1093/ehjci/jeab021. View

12.

Thomas L, Muraru D, Popescu B, Sitges M, Rosca M, Pedrizzetti G . Evaluation of Left Atrial Size and Function: Relevance for Clinical Practice. J Am Soc Echocardiogr. 2020; 33(8):934-952. DOI: 10.1016/j.echo.2020.03.021. View

13.

Andrade J, Wells G, Deyell M, Bennett M, Essebag V, Champagne J . Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation. N Engl J Med. 2020; 384(4):305-315. DOI: 10.1056/NEJMoa2029980. View

14.

Lang R, Badano L, Mor-Avi V, Afilalo J, Armstrong A, Ernande L . Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015; 16(3):233-70. DOI: 10.1093/ehjci/jev014. View

15.

Dretzke J, Chuchu N, Agarwal R, Herd C, Chua W, Fabritz L . Predicting recurrent atrial fibrillation after catheter ablation: a systematic review of prognostic models. Europace. 2020; 22(5):748-760. PMC: 7203634. DOI: 10.1093/europace/euaa041. View

16.

Ciuffo L, Tao S, Ipek E, Zghaib T, Balouch M, Lima J . Intra-Atrial Dyssynchrony During Sinus Rhythm Predicts Recurrence After the First Catheter Ablation for Atrial Fibrillation. JACC Cardiovasc Imaging. 2018; 12(2):310-319. PMC: 6043414. DOI: 10.1016/j.jcmg.2017.11.028. View

17.

Vogler J, Willems S, Sultan A, Schreiber D, Luker J, Servatius H . Pulmonary Vein Isolation Versus Defragmentation: The CHASE-AF Clinical Trial. J Am Coll Cardiol. 2015; 66(24):2743-2752. DOI: 10.1016/j.jacc.2015.09.088. View

18.

Pathan F, Sivaraj E, Negishi K, Rafiudeen R, Pathan S, DElia N . Use of Atrial Strain to Predict Atrial Fibrillation After Cerebral Ischemia. JACC Cardiovasc Imaging. 2017; 11(11):1557-1565. DOI: 10.1016/j.jcmg.2017.07.027. View

19.

Badano L, Kolias T, Muraru D, Abraham T, Aurigemma G, Edvardsen T . Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2018; 19(6):591-600. DOI: 10.1093/ehjci/jey042. View

20.

Mairesse G, Moran P, Van Gelder I, Elsner C, Rosenqvist M, Mant J . Screening for atrial fibrillation: a European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y.... Europace. 2017; 19(10):1589-1623. DOI: 10.1093/europace/eux177. View