Utility of left atrial strain in characterizing patients with reablated atrial fibrillation

Abstract Introduction and Objectives Atrial fibrillation (AF) is a highly prevalent condition, with projections indicating it will increase in the future. Various ablation techniques exist to try to eliminate the arrhythmia, but the problem of recurrences and the need for reinterventions are not uncommon. We need markers to predict which patients will benefit from these procedures and which will recur despite our efforts. Atrial strain techniques have emerged as a novel tool in assessing the function and degree of atrial fibrosis, which could improve patient selection and increase the success of procedures. Methods A retrospective analysis was conducted, including adult patients who had undergone echocardiography at our center during the years 2023-2024. A total of 59 healthy patients with no history of cardiovascular disease, labeled as "normal studies" by the examiner, served as the control group, and another group of 47 patients with recurrent AF with at least two ablation procedures were included. Various left atrial strain values (Reservoir, Conduit, and Pump) of each patient were analyzed. Descriptive statistics were calculated for each group and segment, and the Mann-Whitney U test was used to compare the groups. Results Patients with reablated AF showed significantly lower absolute strain values compared to normal patients in all three analyzed varieties (Reservoir, Conduit, and Pump) with p<0.01 for all comparisons. The mean strain in the control group was 41.80 for reservoir strain, -24.01 for conduit strain, and -17.07 for pump strain; while the mean in the AF group was 17.42, -11.72, and -6.33, respectively. Conclusions We found significant differences in left atrial strain values between normal patients and patients with reablated AF. These findings suggest that left atrial strain could be useful in selecting patients for AF ablation procedures, as those more prone to recurrence exhibit lower absolute strain values, indicating a higher degree of atrial fibrosis where anomalous circuits may establish and perpetuate the arrhythmia over time. Normal Vs Atrial fibrillation