The role of left atrial peak systolic strain in atrial fibrillation
recurrence after catheter ablation. A systematic review and
meta-analysis.
Abstract
Background: This systematic review and meta-analysis was performed to
assess the prognostic role of left atrial peak systolic longitudinal
strain (LA-PLSsys) as a predictor of atrial fibrillation (AF) recurrence
after catheter ablation. Methods We systematically searched major
electronic databases and grey literature for studies assessing the role
of preablation LA-PLSsys, measured in at least 2 segments, in
post-ablation AF recurrence, after a follow up period of at least 6
months. Results: 17 eligible studies were included, resulting in 1704
patients (68.6% men) with a pooled mean age of 59.9±10.6 years, 65.9%
with paroxysmal AF. Recurrence occurred in 32.7% of patients. Those
without recurrence had significantly higher LA-PLSsys (pooled mean±SD:
22.22%±10.64%, weighted mean difference: 5.43%, 95%CI: 4.03-6.84%,
I2: 82.7%). Subgroup analysis revealed that methodology used
(echocardiographic view and segments assessed) was a significant source
of heterogeneity (p=0.02), while meta-regression analysis demonstrated
that the effect size was inversely related to the baseline LA volume
index (p=0.004). Conclusions: Pre-ablation LA-PLSsys seems to be a
useful predictor of post-ablation AF recurrence. However, data for
patients with persistent AF and severe LA dilation are still lacking,
thus no safe conclusion can be made for this challenging subgroup.
Moreover, use of different methodology seems to introduce bias in the
effort to obtain a universal cutoff value. Whether LA strain may be of
clinical use, which would require better methodological definition and
deriving a reference range - with adequate positive and negative
predictive value for recurrence - is subject to further investigation.