Work

Right atrial strain in atrial fibrillation: the hidden side of the moon

Year: 2025

Type: article

Abstract: Background: Although assessment of left atrium (LA) abnormalities has been extensively studied in atrial fibrillation (AF), structural and functional changes in the right atrium (RA) have remained almost unexplored in this context. We investigated the role of bi-atrial strain in patients with AF undergoing catheter ablation (CA).Methods: Fifty-six consecutive patients undergoing catheter ablation of AF were prospectively studied with speckle-tracking echocardiography and electrophysiological study, before and after CA (median follow-up: 7±3 months). A group of 32 subjects undergoing CA of paroxysmal atrioventricular node-reentrant tachycardia, without structural heart disease, served as control group.Results: Patients with AF had worse LA, but also RA strain indexes compared to controls (RA strain,pRASr:22.1±12.6vs.29.8±12.7%, p=0.009;RA dispersion,SD-regional-RA-TTP:0.048±0.015vs.0.038±0.009,p=0.020). Patients with persistent AF showed similar LA strain values, but worse RA strain indexes, compared to patients with paroxysmal AF (pRASr: 24.8±12.1vs15.9±11.7%,p=0.017;SD-regional-RA-TTP:0.043±0.023vs.0.062±0.030,p=0.016). RA function showed a significant relation with both LA strain and volume indexes and with abnormal LA electroanatomical substrate (pRASr and pLASr, Pearson correlation: r 0.594,p< 0.001;pRASr and low-voltage LA area: -0.316, p=0.018). RA, but not LA, parameters were found significantly reduced in patients with AF recurrence post-CA compared to those who maintain sinus rhythm (pRASr: 14.1±11.7vs.24.6±13.5,p=0.039;SD-regional-RA-TTP:0.054±0.031vs.0.032±0.010,p=0.002), while the only independent clinical predictor of AF recurrence remained cardiovascular risk profile (CHA2DS2 VASc Score: HR 1.47,CI 1.003-2.158,p= 0.048).Conclusions: RA function, as assessed by strain imaging, resulted progressively impaired in worse subtypes of AF, showing a strong correlation with bi-atrial mechanical and electroanatomical parameters, and associated with AF recurrences post-ablation.

Source: Frontiers in Cardiovascular Medicine

DOI: 10.3389/fcvm.2025.1578524