Relationship between cardiac structure and function and atrial fibrillation related hospitalizations following catheter ablation. (25th November 2020)

• Record Type: Journal Article
• Authors: Olsen, F.J; Darkner, S; Chen, X; Pehrson, S; Johannessen, A; Hansen, J; Gislason, G; Svendsen, J.H; Biering-Sorensen, T
• Is Part Of: European heart journal. Volume 41:(2020)Supplement 2
• Publication Date: 2020-11-25
• Subjects: Tissue Doppler, Speckle Tracking and Strain Imaging; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/ehjci/ehaa946.0120
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: Even though catheter ablation (CA) is an effective treatment for atrial fibrillation (AF), AF-related hospitalizations and cardioversions are common following this procedure. Purpose: To investigate whether echocardiographic measures of left atrial (LA) function could predict AF-related hospitalizations and cardioversions. Methods: This was a substudy of a trial that randomized patients to amiodarone vs place to reduce AF recurrence following CA. Transthoracic echocardiography was performed prior to CA and included assessment of: end-systolic and end-diastolic LA volumes, emptying fraction (LAEF), atrial strain, and global longitudinal strain (GLS). Poisson regression was used to assess predictive value for AF-related hospitalizations and cardioversions. Multivariable adjustments were made for: age, gender, ejection fraction, AF burden, AF subtype, dyspnea, and class 1c antiarrhythmics. Results: Of the 212 patients, 80 were hospitalized for AF (206 times), and 77 were cardioverted (192 times) within the 6 months follow-up period. Mean age was 60 years, 83% were men, and mean LVEF was 50%. In univariable analyses, LA volumes, LAEF and GLS were predictors of the outcomes but did not remain significant predictors after multivariable adjustments. During echocardiography 162 patients were in sinus rhythm and 50 had AF rhythm. Rhythm during the echocardiogram modified the association between GLS and outcomes (p for interaction <0.05 for both endpoints), such that GLS predicted both AF-related hospitalizations and cardioversions in patients with sinus rhythm but not AF during the echocardiogram (figure). Conclusion: Global longitudinal strain predicts AF-related hospitalizations and cardioversions after CA, but only in patients presenting in sinus rhythm during the echocardiogram. Patients presenting with impaired global longitudinal strain should be considered high-risk patients following CA who may benefit from close follow-up. Funding Acknowledgement: Type of funding source: Foundation. Main funding source(s): The Danish Heart Foundation