Echocardiographic parameters indicating left atrial reverse remodeling after catheter ablation for atrial fibrillation

Eleonora Angelini; Jan-Thorben Sieweke; Dominik Berliner; Saskia Biber; Stephan Hohmann; Maximiliane Oldhafer; Sven Schallhorn; David Duncker; Christian Veltmann; Johann Bauersachs; Udo Bavendiek

doi:10.3389/fcvm.2023.1270422

Echocardiographic parameters indicating left atrial reverse remodeling after catheter ablation for atrial fibrillation

Front Cardiovasc Med. 2023 Dec 18:10:1270422. doi: 10.3389/fcvm.2023.1270422. eCollection 2023.

Affiliations

¹ Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
² Center for Electrophysiology, Klinikum Links der Weser, Bremen, Germany.

^# Contributed equally.

Abstract

Background: The echocardiographic parameters total atrial conduction time (PA-TDI duration), left atrial (LA) volume index (LAVI), and LA strain reflect adverse atrial remodeling and predict atrial fibrillation (AF).

Objectives: The aim of this study was to investigate echocardiographic parameters indicating reverse LA remodeling and potential associations with AF recurrence after pulmonary vein isolation (PVI).

Methods: This prospective observational study consecutively enrolled patients scheduled for PVI for symptomatic AF. Electrocardiogram (ECG) test and transthoracic echocardiography were performed the day before and after PVI and again 3 months later. AF recurrence was determined by Holter ECG at 3 months, and telephone follow-up at 12 months, after PVI. The parameters of LA remodeling [PA-TDI, LAVI, and LA strain analysis: reservoir strain (LASr), conduit strain (LAScd), contraction strain (LASct)] were determined by transthoracic echocardiography.

Results: A total of 48 patients were included in the study (mean age: 61.4 ± 12.2 years). PA-TDI significantly decreased the day after PVI compared with the baseline (septal PA-TDI 103 ± 13 vs. 82 ± 14.9 ms, p ≤ 0.001; lateral PA-TDI 122.4 ± 14.8 vs. 106.9 ± 14.4 ms, p ≤ 0.001) and at the 3-month follow-up (septal PA-TDI: 77.8 ± 14.5, p ≤ 0.001; lateral PA-TDI 105.2 ± 16.1, p ≤ 0.001). LAVI showed a significant reduction at the 3-month follow-up compared with the baseline (47.7 ± 14.4 vs. 40.5 ± 9.7, p < 0.05). LASr, LAScd, and LASct did not change after PVI compared with the baseline. AF recurred in 10 patients after PVI (21%). Septal PA-TDI, septal a', and LAVI/a' determined the day after PVI were associated with AF recurrence.

Conclusion: Changes in echocardiographic parameters of LA remodeling and function indicate that functional electromechanical recovery preceded morphological reverse remodeling of the left atrium after PVI. Furthermore, these changes in echocardiographic parameters indicating LA reverse remodeling after PVI may identify patients at high risk of AF recurrence.

Keywords: 2D speckle tracking; atrial conduction time; atrial fibrillation; atrial remodeling; catheter ablation; pulmonary vein isolation.

Grants and funding

The authors declare that no financial support was received for the research, authorship, and/or publication of this article.