Cardiovascular

Left Atrium and Left Atrial Appendage Remodeling Assessed by Echocardiography Predict Atrial Fibrillation Recurrence After Radiofrequency Catheter Ablation.

Zhu B, Qu S, et al. • Clinical cardiology • 2026

TL;DR

LAAS and LAASR, as obtained by 2D-STE, are potential predictors of AF recurrence after RFCA, and incorporating these parameters into predictive models provides extra valuable information to identify patients at higher risk.

Key Findings

Results

One-third of AF patients experienced recurrence within one year after radiofrequency catheter ablation.

100 patients with AF underwent transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) before RFCA
33% of patients experienced AF recurrence during the 1-year follow-up period
Logistic regression and ROC curve analysis were used to identify predictors and evaluate model performance

Results

The AF recurrence group had significantly higher NLR, NT-proBNP, and LAVImin values compared to the non-recurrent group.

Differences in NLR (neutrophil-to-lymphocyte ratio), NT-proBNP, and minimum left atrial volume index (LAVImin) were statistically significant (p < 0.05)
These markers suggest greater systemic inflammation and worse cardiac function in patients who experienced recurrence
These differences were identified through comparison between recurrent and non-recurrent groups prior to RFCA

Results

The AF recurrence group had significantly lower left atrial and left atrial appendage functional parameters compared to the non-recurrent group.

Recurrence group had significantly lower LAEF (left atrial ejection fraction), LAEI (left atrial expansion index), LAA-EV (LAA emptying velocity), LAS (left atrial strain), LASR (left atrial strain rate), LAAS (left atrial appendage strain), and LAASR (left atrial appendage strain rate) (p < 0.05)
These parameters were obtained using two-dimensional speckle tracking echocardiography (2D-STE)
Both TTE and TEE-derived parameters were assessed, capturing both LA and LAA remodeling

Results

Left atrial appendage strain (LAAS) and left atrial appendage strain rate (LAASR) were identified as independent predictors of AF recurrence after RFCA.

Logistic regression analysis identified LAAS and LAASR as potential independent factors contributing to AF recurrence (p < 0.05)
These parameters reflect LAA mechanical remodeling as assessed by 2D-STE via TEE
Incorporating LAAS and LAASR into predictive models provided extra valuable information beyond standard clinical and echocardiographic parameters

Results

Predictive models incorporating LAAS and LAASR demonstrated improved performance for identifying patients at higher risk of AF recurrence.

Prediction efficiency was evaluated using receiver operating characteristic (ROC) curves and area under the curve (AUC)
Adding LAAS and LAASR to preoperative clinical data along with TTE and TEE parameters enhanced model discrimination
The combined model incorporating 2D-STE parameters was superior to models based on clinical data and conventional echocardiography alone

Conclusions

2D-STE-derived LA and LAA parameters may enable early identification of impaired LA/LAA function in AF patients to improve patient selection for RFCA.

Incorporating 2D-STE parameters into preoperative clinical data along with TTE and TEE may identify impaired LA/LAA function early
This approach could aid in choosing suitable patients and improving the benefit ratio of RFCA
The study assessed both reservoir, conduit, and contractile function of the LA through strain and strain rate measurements

What This Means

This research suggests that special ultrasound measurements of the heart's upper-left chambers can predict whether a common heart rhythm treatment will be successful. The study followed 100 patients with atrial fibrillation (an irregular heartbeat) who underwent a procedure called radiofrequency catheter ablation (RFCA), which uses heat energy to destroy the tissue causing the abnormal rhythm. Using advanced ultrasound technology called speckle tracking echocardiography, researchers measured how well the left atrium (LA) and its small pouch-like extension called the left atrial appendage (LAA) were stretching and contracting. After one year, 33% of patients had their irregular heartbeat return. The study found that patients whose atrial fibrillation came back had weaker LA and LAA function before the procedure, as measured by lower strain and strain rate values. Two specific measurements — left atrial appendage strain (LAAS) and left atrial appendage strain rate (LAASR) — were particularly strong predictors of recurrence. When these measurements were added to standard clinical information and conventional ultrasound data, the ability to predict which patients would experience a recurrence improved substantially. This research suggests that performing these advanced ultrasound measurements before the ablation procedure could help doctors better identify which patients are most likely to benefit from the treatment. Patients with more severely impaired LAA function, as detected by these specialized measurements, appear to face a higher risk of the irregular heartbeat returning. This could help guide treatment decisions and potentially improve outcomes by ensuring the procedure is offered to those most likely to have lasting success.

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Citation

Zhu B, Qu S, Li H, Yu D, Liu Y, Ai X, et al.. (2026). Left Atrium and Left Atrial Appendage Remodeling Assessed by Echocardiography Predict Atrial Fibrillation Recurrence After Radiofrequency Catheter Ablation.. Clinical cardiology. https://doi.org/10.1002/clc.70457

Key Findings

What This Means

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