The association of baseline left atrial structure and function measured with cardiac magnetic resonance and pulmonary vein isolation outcome in patients with drug-refractory atrial fibrillation

Background Prognostic significance of left atrial (LA) function in patients with atrial fibrillation (AF) is poorly defined. Objective To examine the association of LA function measured with cardiac magnetic resonance (CMR) feature-tracking and AF recurrence following catheter ablation. Methods One hundred and twenty-one AF patients (72% paroxysmal, mean age 59 ± 10 years) were enrolled. Baseline LA function was measured by calculating passive, active, and total emptying fractions (LAEF) and analysis of global longitudinal strain and strain rates. Patients were followed up for recurrence of AF or atrial tachycardia (AT). Hazard ratios for recurrence were calculated using Cox proportional models adjusted for potential clinical confounders, type of AF, left ventricular ejection fraction, AF duration, LA volume, and late gadolinium enhancement (LGE). Results During a mean follow-up of 18 ± 9 months, 52 patients (43%) experienced recurrent AF/AT. Patients with recurrent AF/AT had higher baseline LA volume index and lower LA passive, and total LAEF (P <.05 for all). The baseline peak LA strain and strain rates in all phases of LA function were lower in the AF/AT recurrence group (P <.01 for all). In multivariable analysis total LAEF, peak LA strain, and systolic and late diastolic strain rates were associated with recurrence. Both peak LA strain and total LAEF improved prediction of recurrent AT/AF compared to the baseline clinical model, including LA LGE (C statistic 0.82 vs 0.77, P <.05 for both total LAEF and peak LA strain). Conclusions LA reservoir function was independently associated with recurrent AF/AT after PVI and can additionally improve risk stratification in patients undergoing PVI.