Hammouda Tarek, Kamel Omnia, Fares Emmanuel, Shehata Ahmed, Baghdady Yasser, El-Damaty Ahmed
Department of Cardiology, Kasr Al Ainy, Cairo University hospitals, Cairo, Egypt.
Department of Cardiology, Aswan heart center, Magdi Yaqoub foundation, Aswan, Egypt.
J Saudi Heart Assoc. 2025 Jul 10;37(3):11. doi: 10.37616/2212-5043.1440. eCollection 2025.
Atrial fibrillation (AF) is a prevalent arrhythmia with significant morbidity. Despite advancements in rhythm control strategies and ablation procedures, approximately 30 % of patients with paroxysmal AF experience recurrence, necessitating predictive tools for better patient stratification. This study evaluates the role of left atrial strain (LAS) and left atrial appendage emptying velocity (LAAeV) as predictors of recurrence, aiming to improve procedural outcomes and patient selection.
A prospective cohort of 32 patients with paroxysmal AF and structurally normal hearts, underwent either cryo- or radiofrequency ablation at a single tertiary center. Pre-ablation evaluations included LAS analysis via transthoracic echocardiography and LAAeV measurement via transesophageal echocardiography. Patients were followed for up to one year post-ablation, with recurrence defined as AF episodes lasting >30 seconds beyond a three-month blanking period. Statistical analyses assessed the predictive value of LAS and LAAeV, individually and in combination.
AF recurrence occurred in 21.9 % of the cohort. Pre-ablation left atrial strain (LAS) values (global LAS ≥33.56 %, sensitivity 85.7 %, specificity 70 %, AUC = 81.4 %, P < 0.05) and left atrial appendage emptying velocity (LAAeV) (≥42.7 cm/s, sensitivity: 100 %, specificity: 87 %, AUC = 94 %, P < 0.001) were significantly associated with freedom from recurrence. The combination of LAS and LAAeV improved predictive accuracy to 100 % sensitivity and 94 % specificity (P value < 0.001). Post-ablation LAS showed inconsistent predictive value, with only apical-2 chamber global LAS achieving statistical significance (P = 0.002). Functional recovery of the left atrium post-ablation was minimal, suggesting limited reversibility of atrial remodeling.
Pre-ablation assessment of LAS and LAAeV provides robust predictors of recurrence in patients undergoing AF ablation. Incorporating these metrics into standard pre-procedural evaluation could optimize patient selection and improve ablation outcomes. Further studies are required to validate age-specific cutoff values and evaluate long-term implications.
心房颤动（AF）是一种常见的心律失常，具有较高的发病率。尽管在节律控制策略和消融手术方面取得了进展，但约30%的阵发性AF患者会复发，因此需要预测工具来更好地对患者进行分层。本研究评估左心房应变（LAS）和左心耳排空速度（LAAeV）作为复发预测指标的作用，旨在改善手术效果和患者选择。
在一个单一的三级中心，对32例阵发性AF且心脏结构正常的患者进行前瞻性队列研究，这些患者接受了冷冻或射频消融治疗。消融前评估包括经胸超声心动图分析LAS和经食管超声心动图测量LAAeV。患者在消融后随访长达一年，复发定义为在三个月的空白期后AF发作持续超过30秒。统计分析评估了LAS和LAAeV单独及联合的预测价值。
该队列中21.9%的患者发生AF复发。消融前左心房应变（LAS）值（整体LAS≥33.56%，敏感性85.7%，特异性70%，AUC = 81.4%，P < 0.05）和左心耳排空速度（LAAeV）（≥42.7 cm/s，敏感性：100%，特异性：87%，AUC = 94%，P < 0.001）与无复发显著相关。LAS和LAAeV的联合将预测准确性提高到100%的敏感性和94%的特异性（P值< 0.001）。消融后LAS显示出不一致的预测价值，只有心尖二腔整体LAS达到统计学意义（P = 0.002）。消融后左心房的功能恢复极小，提示心房重构的可逆性有限。
消融前对LAS和LAAeV的评估为接受AF消融的患者提供了可靠的复发预测指标。将这些指标纳入标准的术前评估可以优化患者选择并改善消融效果。需要进一步的研究来验证特定年龄的截断值并评估长期影响。
