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Predictors of short-term atrial fibrillation recurrence after pulmonary vein isolation: the role of left atrial strain and structural parameters
Session:
Sessão de Posters 54 - Da energia aos endpoints na FA
Speaker:
Luísa Pinheiro
Congress:
CPC 2026
Topic:
C. Arrhythmias and Device Therapy
Theme:
04. Arrhythmias, General
Subtheme:
04.2 Arrhythmias, General – Epidemiology, Prognosis, Outcome
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Mariana Tinoco; Luísa Pinheiro; Emidio Mata; Bárbara Lage Garcia; Filipa Castro; Margarida Castro; Mário Lourenço; Ana Sofia Gonçalves; Lucy Calvo; Silvia Ribeiro; Olga Azevedo; António Lourenço
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt">Background:</span></strong><span style="font-size:11.0pt"> Atrial fibrillation (AF) is the most common arrhythmia, significantly affecting quality of life. Pulmonary vein isolation (PVI) is a key treatment, but recurrence remains a challenge. Left atrial (LA) structural and functional parameters, including LA strain (LAS) assessed via echocardiography, have emerged as potential predictors of post-ablation AF recurrence.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt">Aim:</span></strong><span style="font-size:11.0pt"> To assess baseline comorbidities and echocardiographic differences between recurrent and non-recurrent patients undergoing PVI for AF.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt">Methods: </span></strong><span style="font-size:11.0pt">This retrospective, single-center study included AF patients who underwent first-time PVI (2015-2024) with prior echocardiographic evaluation available. </span><span style="font-size:11.0pt">Echocardiographic images were reanalyzed, with LAS and volume measured when quality permitted. </span><span style="font-size:11.0pt">AF recurrence was assessed at 6 and 12 months using 12-lead ECGs or available rhythm Holter monitoring.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt">Results: </span></strong><span style="font-size:11.0pt">Seventy-two patients met inclusion criteria. Sixty completed 6-month follow-up, and 51 completed 12-month follow-up. The median time from echocardiography to PVI was 312 days [IQR 120–610]. AF recurrence occurred in 9 patients (15.0%) at 6 months and 15 (29.4%) at 12 months. Recurrent patients at 12 months were older (69.5 vs 60.2 years p=0.01), while prior comorbidities and antiarrhythmic drug use were similar between groups. Time from AF diagnosis to ablation was longer in recurrent patients but not statistically significant (6 months: 1435 vs 960 days p=0.39; 12 months: 1435 vs 960 days p=0.26). At 12 months, AF recurrence was associated with a larger pre-PVI indexed LA diameter (23.3±3.5 vs 20.5±2.6 mm/m² p=0.01) and lower E′ lateral (9.5±3.0 vs 12.5±3.0 cm/s p=0.01). At 6 months, recurrent patients also had significantly lower pre-PVI E′ lateral (9.3±3.5 vs 12.0±2.9 cm/s p=0.02). Although LA reservoir strain trended lower in recurrent patients at 12 months (20.2±7.3% vs 25.7±7.7% p=0.08), it did not reach statistical significance. Other parameters, including conduit and contraction strain, indexed LA volume, left ventricular global longitudinal strain, and E/e′ ratio, showed no significant differences between groups.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt">Discussion:</span></strong> <span style="font-size:11.0pt">The small sample size, low inclusion rate, and long interval between echocardiography and PVI may limit generalizability and accuracy. Although LA strain did not predict AF recurrence in this study, these limitations prevent definitive conclusions. Larger prospective studies with shorter imaging-to-PVI intervals are needed to confirm its prognostic value.</span></span></span></p> <p> </p>
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