Clinical Perspective
death, cardiovascular complications, markedly reduced LA, myocardial deformation
RECURRENCE, ATRIAL FIBRILLATION (AF), PERSISTENT ATRIAL FIBRILLATION, CONTRACTION, CARDIOVASCULAR COMPLICATIONS
Cardiac parameters such as increased left atrial (LA) size and reduced reservoir function in paroxysmal atrial fibrillation (AF), early persistent, and persistent AF are associated with AF recurrence following ablation. There is sparse information on the impact of ablation on LA size and function in patients suffering from long-standing persistent AF. The recently reported CASA-AF randomized-controlled trial (Catheter Ablation vs. Thoracoscopic Surgical Ablation in Long Standing Persistent Atrial Fibrillation) showed similar success rates between catheter ablation and thoracoscopic surgical ablation in patients with long-standing persistent AF. This substudy from the CASA-AF trial shows LA and overall cardiac function does not differ between catheter and surgical ablation. However, irrespective of the ablation technique, patients with lower LA contractile function following ablation are more likely to have AF recurrence. This study suggests that following ablation for long-standing persistent AF, those with markedly reduced LA contractile function are at a higher risk of developing AF recurrence and require closer monitoring during follow-up, focusing on alternative rate and rhythm control strategies. This study provides background information on future research to study the relationship of LA strain with fibrotic changes on cardiac magnetic resonance imaging or histology.Atrial fibrillation (AF) is an epidemic with the highest prevalence in industrialized countries, associated with an increased risk of cardiovascular complications and death.The LA functions sequentially as a reservoir, conduit, and pump during the cardiac cycle.Transthoracic echocardiography comprehensively assesses LA structure and function by deriving LA volumes and using 2D speckle tracking strain imaging to quantify myocardial deformation during LA relaxation and contraction.In the CASA-AF trial (Catheter Ablation vs. Thoracoscopic Surgical Ablation in Long Standing Persistent Atrial Fibrillation), we previously showed similar efficacy of catheter ablation and surgical ablation for maintaining SR in patients with LSPAF.The aims of this sub-study were (i) to assess the effect of ablation therapy on LA structure and function in LSPAF; (ii) to compare LA structure and function in patients maintaining SR and those with AF recurrence following ablation, and (iii) to determine the independent predictors of AF recurrence following ablation.