Prediction of atrial fibrillation recurrence following one-year catheter ablation using atrial mechanical dispersion assessed by speckle tracking echocardiography

Abstract

Atrial fibrillation (AF) is the most common arrhythmia, impacting life quality and healthcare costs. Catheter ablation has become the cornerstone for rhythm control but is associated with a high recurrence rate, emphasizing the need for early diagnosis to optimize treatment. AF progresses through atrial remodeling, affecting structure, function, and electrical properties. Although left atrial size remains a routine measure, AF recurrence can occur in patients without left atrial enlargement, suggesting that functional changes may precede structural alterations. Intra-atrial dyssynchrony, a predictor of AF recurrence, is represented by atrial mechanical dispersion, defined as the standard deviation of the time to peak positive strain (SD-TPS).

This study retrospectively enrolled 132 AF patients undergoing their first catheter ablation between December 2017 and January 2019. All analyses were censored after a follow-up time of 1 year. Key findings included: (1) a 22.7% recurrence rate post-ablation; (2) no significant difference in left atrial volume index (LAVI) among patients with and without AF recurrence; (3) an association between atrial mechanical dispersion and AF recurrence risk; (4) an SD-TPS cut-off of 38.6 msec that may help identify high-risk patients; and (5) multivariable analysis highlighted age as the most critical risk factor, with SD-TPS being the most relevant imaging variable.

These results suggest that SD-TPS can detect early atrial dysfunction, even in patients with normal LAVI, and may help predict AF recurrence. Incorporating atrial mechanical dispersion into comprehensive assessments could improve risk stratification.