Iannaccone Giulia, Scacciavillani Roberto, Graziani Francesca, Tusa Filippo, Piccinni Carlo, Gabrielli Francesca Augusta, Narducci Maria Lucia, Perna Francesco, Camilli Massimiliano, Meucci Maria Chiara, Montone Rocco A, Bencardino Gianluigi, Lanza Gaetano Antonio, Pelargonio Gemma, Lombardo Antonella
Department of Cardiovascular Sciences-CUORE, Catholic University of the Sacred Heart, 00168 Rome, Italy.
Department of Cardiovascular Sciences-CUORE, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
J Clin Med. 2025 Jul 24;14(15):5247. doi: 10.3390/jcm14155247.
This study aimed to evaluate the effectiveness of right and left atrial strain reservoir (RASr and LASr) in predicting the recurrence of atrial arrhythmias (AAs) following cavotricuspid isthmus ablation (CTIA) for typical atrial flutter (AFL). We retrospectively enrolled consecutive patients with AFL who had undergone CTIA. Transthoracic echocardiography was conducted within one month before the procedure, and atrial two-dimensional speckle tracking analysis was performed offline. Sixty-two subjects were evaluated (mean age 64.8 ± 13.2 years, 29% females). At a median follow-up of 12.1 months, AA recurrence occurred in 21 subjects (33.8%). The study endpoint occurred mainly among females ( = 0.021) and patients with lower RASr and LASr values (both < 0.001). In Cox regression analysis, RASr and LASr remained independent predictors of AA recurrence ( = 0.02 and = 0.03, respectively). In ROC curve analysis, RASr and LASr showed a similar and satisfactory ability to predict AA recurrence with optimal cut-off values of 16.8% and 17.7%, respectively. In survival analysis, RASr > 16.8% and LASr > 17.7% were associated with significantly higher freedom from AAs during follow-up (log rank = 0.001 and = 0.002, respectively). The results of this study suggest that pre-CTIA atrial speckle tracking analysis may aid in identifying AFL patients at an increased risk of AA recurrence, allowing for more frequent follow-up visits and extended antiarrhythmic therapy.
本研究旨在评估右心房和左心房应变储备（RASr和LASr）对典型心房扑动（AFL）行三尖瓣峡部消融（CTIA）术后房性心律失常（AA）复发的预测效果。我们回顾性纳入了连续接受CTIA的AFL患者。在手术前1个月内进行经胸超声心动图检查，并离线进行心房二维斑点追踪分析。共评估了62名受试者（平均年龄64.8±13.2岁，29%为女性）。中位随访12.1个月时，21名受试者（33.8%）出现AA复发。研究终点主要发生在女性（P = 0.021）以及RASr和LASr值较低的患者中（均P < 0.001）。在Cox回归分析中，RASr和LASr仍然是AA复发的独立预测因素（分别为P = 0.02和P = 0.03）。在ROC曲线分析中，RASr和LASr显示出相似且令人满意的预测AA复发的能力，最佳截断值分别为16.8%和17.7%。在生存分析中，RASr > 16.8%和LASr > 17.7%与随访期间AA-free显著更高相关（对数秩检验分别为P = 0.001和P = 0.002）。本研究结果表明，CTIA术前心房斑点追踪分析可能有助于识别AA复发风险增加的AFL患者，从而允许更频繁的随访和延长抗心律失常治疗。
