Intra-Atrial Dyssynchrony During Sinus Rhythm Predicts Recurrence After the First Catheter Ablation for Atrial Fibrillation

Abstract Objectives The purpose of this study was to evaluate the usefulness of intra-atrial dyssynchrony as a marker of underlying left atrial (LA) remodeling to predict recurrence after the first atrial fibrillation (AF) ablation. Background Catheter ablation for AF remains far from curative with relatively high recurrence rates. One of the causes of recurrence is poor patient selection out of a diverse patient population with different degrees of LA remodeling. Methods We included 208 patients with a history of AF (59.4 ± 10 years of age; 26.0% nonparoxysmal AF) referred for catheter ablation of AF who underwent pre-ablation cardiac magnetic resonance in sinus rhythm. Clinical follow-up was 20 ± 6 months. Using tissue tracking cardiac magnetic resonance, we measured the LA longitudinal strain in each of 12 equal-length segments in 2- and 4-chamber views. We defined intra-atrial dyssynchrony as the standard deviation of the time to the peak longitudinal strain corrected by the cycle length (SD-time to peak strain [TPS], %). Results Patients with AF recurrence after ablation (n = 101) had significantly higher SD-TPS than those without (n = 107; 3.9% vs. 2.2%; p  Conclusions Intra-atrial dyssynchrony during sinus rhythm is an independent predictor of recurrence after the first catheter ablation of paroxysmal or persistent AF. Assessment of intra-atrial dyssynchrony may improve ablation outcomes by refining patient selection.