Left atrium (LA) structural remodeling associated with atrial fibrillation (AF) contributes to recurrence after AF catheter ablation (CA). Characterizing LA function may be useful to identify patients with higher risk of recurrence and could guide ablation strategy in term of substrate modification. We aimed to identify predictors of recurrence and atrial remodeling by assessing LA and left ventricle (LV) deformation properties using two-dimensional speckle-tracking imaging before and after AF CA.

62 patients (age 54±10 years, 90% male) with AF (45 paroxysmal (PAF), 17 persistent (PsAF)) underwent an echocardiography before CA, 3 and 6 months after CA to assess LA strain (S total (S-tot), positive peak (S-pos), negative peak (S-neg)), LA strain rate (SR positive peak (SRs), early (SRe) and late negative peak (SRa)) and LV strain (LV longitudinal and radial S).

PsAF patients baseline had significantly larger LA volumes (41±8 vs 32±10ml/m²), decreased S-tot (10±5 vs 20±6%; p<0.001), SR-LAs (0.6±0.2 vs 1±0.3s⁻¹; p<0.001) and LV strain (−12±3 vs −16±3%; p<0.001) compared to PAF group. After 6 month follow-up, 69% of the patients remained in sinus rhythm. Baseline LA active emptying, reservoir function and LA S-tot (13.2±6.2 vs 20.1±7%, p<0.001), S-neg (−7.2±3.5 vs –10.6±3.3%, p<0.009), SR-s (0.71±0.3 vs 1.01±0.35 s⁻¹, <0.004), SR-a (–0.89±0.56 vs −1.37±0.48 s⁻¹, p<0.01) and LV strain (−13.5±4.8 vs −17.1±3.5%, p<0.003) were significantly decreased in patients with AF recurrence. At multivariate analysis, the unique independent predictor of sinus rhythm maintenance was LA S-tot (HR 0.819 (0.685–0.979), p=0.028). In the overall cohort, LA volumes decreased from baseline to 3 and 6 months but there was no significant change in LA S, LA SR nor LV strain. At multivariate analysis, the unique independent predictor of LA reverse remodeling after CA was the duration of AF history (HR 0.84 (0.73–0.96), p=0.013).

Altered global LA and LV strain before CA is associated with AF recurrence. Echocardiographic LA function characterization before ablation procedures may be helpful to guide AF ablation strategy and drug management after CA.