Echocardiographic Predictors of Atrial Fibrillation Recurrence After Ablation: Insights from University Hospital Centre Zagreb

    Authors

    Keywords

    atrial fibrillation, echocardiography, catheter ablation

    DOI

    https://doi.org/10.15836/ccar2025.108

    Full Text

    **Introduction:** Echocardiographic measurements, such as left atrial (LA) volume, strain, and diastolic dysfunction, have been identified as valuable predictors of atrial fibrillation (AF) recurrence after ablation (1, 2). These factors are associated with structural remodelling, including atrial myocardial fibrosis, which may contribute to an increased likelihood of recurrence (3). In this study, we aimed to evaluate echocardiographic predictors of AF recurrence in our patient population. **Patients and Methods:** We conducted a retrospective analysis of patients who underwent AF ablation between February 2022 and September 2024. AF recurrence during follow-up up was recorded. Data comparison between patients with and without recurrence was performed using t-tests and chi-square. **Results:** A total of 39 patients with preprocedural echocardiography examination available for further analysis were identified and included in the analysis. Baseline characteristics, laboratory findings, and echocardiographic measurements are summarized in **Table 1**. Statistical analysis revealed a significant difference between the recurrence and non-recurrence groups in LA reservoir strain (p=0.002) and E/e’ ratio (p<0.001). ### TABLE 1: Statistical analysis of echocardiographic measurements. | | **No recurrence** | **AF recurrence** | **p value** | | --- | --- | --- | --- | | Age | 63.83±8.43 | 68.27±9.57 | 0.138 | | Female | 10 (41.7%) | 7 (46.7%) | 0.759 | | NTproBNP | 125.75±80.83 | 1222.17±2493.77 | 0.142 | | Diastolic dysfunction | Grade 0 = 4 (16.7%) Grade 1 = 16 (66.7%) Grade 2 = 4 (16.7%) | Grade 0 = 0 (0.0%) Grade 1 = 8 (53.3%) Grade 2 = 7 (46.7%) | 0.057 | | LAVI | 34.38±7.79 | 38.07±9.68 | 0.198 | | LA strain | 26.58±5.30 | 19.33±8.23 | 0.002 | | RAV | 33.08±9.98 | 37.13±9.93 | 0.224 | | RAA | 14.13±2.74 | 14.93±2.52 | 0.362 | | sPAP | 21.71±6.92 | 23.54±8.41 | 0.519 | | Deceleration time | 268.13±83.38 | 236.40±79.46 | 0.247 | | E/A | 1.03±0.40 | 1.61±0.51 | 0.381 | | IVRT | 101.46±24.98 | 105.93±32.77 | 0.632 | | E/e’ | 6.75±1.82 | 9.60±2.32 | <0.001 | | | | | | | Total | 24 (61.5%) | 15 (38.5%) | | [†] LAVI - left atrium indexed volume, LA – left atrium, RAV - right atrium volume, RAA- right atrium area, sPAP - systolic pulmonary artery pressure, E/A - transmitral E wave and A wave ratio, IVRT - isovolumic relaxation time, E/e’ - peak early diastolic velocity of mitral inflow and mitral annular motion ratio **Conclusion:** Although our study is limited by a small sample size, the findings align with previous research, suggesting that LA strain and E/e’ ratio may serve as valuable predictors of atrial fibrillation recurrence. Future studies with larger cohorts are needed to confirm these results and integrate these echocardiographic parameters into clinical management strategies.

    Literature

    1. Liżewska-Springer A, Dąbrowska-Kugacka A, Lewicka E, Drelich Ł, Królak T, Raczak G. Echocardiographic predictors of atrial fibrillation recurrence after catheter ablation: A literature review. Cardiol J. 2020;27(6):848–56. https://doi.org/10.5603/CJ.a2018.0067
    2. Karanikola AE, Tzortzi M, Kordalis A, Doundoulakis I, Antoniou CK, Laina A, et al. Clinical, Electrocardiographic and Echocardiographic Predictors of Atrial Fibrillation Recurrence After Pulmonary Vein Isolation. J Clin Med. 2025 January 26;14(3):809. https://doi.org/10.3390/jcm14030809
    3. Hopman LHGA, Mulder MJ, van der Laan AM, Demirkiran A, Bhagirath P, van Rossum AC, et al. Impaired left atrial reservoir and conduit strain in patients with atrial fibrillation and extensive left atrial fibrosis. J Cardiovasc Magn Reson. 2021 November 11;23(1):131. https://doi.org/10.1186/s12968-021-00820-6
    Cardiologia Croatica
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    Echocardiographic Predictors of Atrial Fibrillation Recurrence After Ablation: Insights from University Hospital Centre Zagreb

    Extended Abstract
    Issue5-6
    Published
    Pages108-109
    PDF via DOIhttps://doi.org/10.15836/ccar2025.108
    atrial fibrillation
    echocardiography
    catheter ablation

    Authors

    Iva Golubić*ORCIDSpecial Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice, Croatia
    Antun Zvonimir KovačORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Sandra Jakšić JurinjakORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Marija BrestovacORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Vedran VelagićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Ivan PrepolecORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Andrija NekićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Vedran PašaraORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Vlatka Rešković LukšićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

    *Correspondence email: iva.golubic91@gmail.com

    Full Text

    Introduction: Echocardiographic measurements, such as left atrial (LA) volume, strain, and diastolic dysfunction, have been identified as valuable predictors of atrial fibrillation (AF) recurrence after ablation (1, 2). These factors are associated with structural remodelling, including atrial myocardial fibrosis, which may contribute to an increased likelihood of recurrence (3). In this study, we aimed to evaluate echocardiographic predictors of AF recurrence in our patient population.

    Patients and Methods: We conducted a retrospective analysis of patients who underwent AF ablation between February 2022 and September 2024. AF recurrence during follow-up up was recorded. Data comparison between patients with and without recurrence was performed using t-tests and chi-square.

    Results: A total of 39 patients with preprocedural echocardiography examination available for further analysis were identified and included in the analysis. Baseline characteristics, laboratory findings, and echocardiographic measurements are summarized in Table 1. Statistical analysis revealed a significant difference between the recurrence and non-recurrence groups in LA reservoir strain (p=0.002) and E/e’ ratio (p<0.001).

    TABLE 1: Statistical analysis of echocardiographic measurements.

    Age
    No recurrence
    63.83±8.43
    AF recurrence
    68.27±9.57
    p value
    0.138
    Female
    No recurrence
    10 (41.7%)
    AF recurrence
    7 (46.7%)
    p value
    0.759
    NTproBNP
    No recurrence
    125.75±80.83
    AF recurrence
    1222.17±2493.77
    p value
    0.142
    Diastolic dysfunction
    No recurrence
    Grade 0 = 4 (16.7%) Grade 1 = 16 (66.7%) Grade 2 = 4 (16.7%)
    AF recurrence
    Grade 0 = 0 (0.0%) Grade 1 = 8 (53.3%) Grade 2 = 7 (46.7%)
    p value
    0.057
    LAVI
    No recurrence
    34.38±7.79
    AF recurrence
    38.07±9.68
    p value
    0.198
    LA strain
    No recurrence
    26.58±5.30
    AF recurrence
    19.33±8.23
    p value
    0.002
    RAV
    No recurrence
    33.08±9.98
    AF recurrence
    37.13±9.93
    p value
    0.224
    RAA
    No recurrence
    14.13±2.74
    AF recurrence
    14.93±2.52
    p value
    0.362
    sPAP
    No recurrence
    21.71±6.92
    AF recurrence
    23.54±8.41
    p value
    0.519
    Deceleration time
    No recurrence
    268.13±83.38
    AF recurrence
    236.40±79.46
    p value
    0.247
    E/A
    No recurrence
    1.03±0.40
    AF recurrence
    1.61±0.51
    p value
    0.381
    IVRT
    No recurrence
    101.46±24.98
    AF recurrence
    105.93±32.77
    p value
    0.632
    E/e’
    No recurrence
    6.75±1.82
    AF recurrence
    9.60±2.32
    p value
    <0.001
    Row 14
    Total
    No recurrence
    24 (61.5%)
    AF recurrence
    15 (38.5%)

    LAVI• left atrium indexed volume, LA – left atrium, RAV• right atrium volume, RAA- right atrium area, sPAP• systolic pulmonary artery pressure, E/A• transmitral E wave and A wave ratio, IVRT• isovolumic relaxation time, E/e’• peak early diastolic velocity of mitral inflow and mitral annular motion ratio

    Conclusion: Although our study is limited by a small sample size, the findings align with previous research, suggesting that LA strain and E/e’ ratio may serve as valuable predictors of atrial fibrillation recurrence. Future studies with larger cohorts are needed to confirm these results and integrate these echocardiographic parameters into clinical management strategies.

    Literature

    1. 1.
      Liżewska-Springer A, Dąbrowska-Kugacka A, Lewicka E, Drelich Ł, Królak T, Raczak G. Echocardiographic predictors of atrial fibrillation recurrence after catheter ablation: A literature review. Cardiol J. 2020;27(6):848–56.DOI
    2. 2.
      Karanikola AE, Tzortzi M, Kordalis A, Doundoulakis I, Antoniou CK, Laina A, et al. Clinical, Electrocardiographic and Echocardiographic Predictors of Atrial Fibrillation Recurrence After Pulmonary Vein Isolation. J Clin Med. 2025 January 26;14(3):809.DOI
    3. 3.
      Hopman LHGA, Mulder MJ, van der Laan AM, Demirkiran A, Bhagirath P, van Rossum AC, et al. Impaired left atrial reservoir and conduit strain in patients with atrial fibrillation and extensive left atrial fibrosis. J Cardiovasc Magn Reson. 2021 November 11;23(1):131.DOI