AF recurrence is common post catheter ablation. AF recurrence is associated with symptomatic deterioration, thromboembolic events, hospital admissions and worse prognosis. Therefore, definition of an accurate and easily obtainable predictor of AF recurrence is of crucial importance.
AF is associated with left atrial (LA) structural remodeling and functional deterioration due to a variable degree of myocardial hypertrophy, disarray, apoptosis and fibrosis. In clinical practice, M mode and B mode echocardiography-derived indices of LA size are routinely used to assess left atrium (LA). However, these parameters have important limitations to describe complex myocardial changes associated with AF.
Speckle tracking is an echocardiographic technique which has gradually gained relevance in the last decade. Quantification of myocardial deformation based on SLE overcomes most of the limitations of classic echocardiography and provides an early detection of myocardial funticonal impairment. Today, its feasibility and usefulness to measure LA function are highly supported by literature and several studies demonstrated that STE could provide additional prognostic information beyond conventional echocardiographic parameters.
Recent advances in echocardiography equipment and image post-processing allow an assessment of LA strain and strain rate. The speckle-tracking echocardiography (STE)-derived LA longitudinal strain has been shown to be an accurate and reproducible parameter to evaluate LA longitudinal shortening. Furthermore, LA strain has significantly correlated with underlying LA fibrosis.
A recent standardization of speckle tracking analysis regarding all cardiac chambers supported the integration of STE in diagnostic and prognostic protocols in daily practice. This suggests that LA strain provides a comprehensive and quantitative assessment of LA structure and function. Hence, it is tempting to speculate that the analysis of LA strain will show high accuracy to predict AF recurrence post catheter ablation. However, LA strain can be affected by several factors not related to LA structural damage such as loading conditions or arrhythmias. Moreover, in the real-world setting, the value of LA strain to predict AF recurrence following catheter ablation is not known.
Therefore, the aim of the present study is fourfold:
(1. To evaluate feasibility of STE-derived strain assessment in patients undergoing catheter ablation for paroxysmal or persistent AF.
(2. To determine the acute effect of catheter ablation on LA structure and function.
(3. To define echocardiographic predictors of AF recurrence during long-term follow-up.
(4. To define the role of LA strain in the diagnosis of HFpEF in patients with history of AF
