Avaliação da técnica do strain do átrio esquerdo em pacientes portadores de fibrilação atrial antes e após ablação

Abstract

Introduction: Diastolic assessment in patients with atrial fibrillation (AF) is a complex task. As the most common arrhythmia worldwide, affecting approximately 2% of the population, left atrial strain has emerged as a valuable tool in evaluating patients with heart failure with preserved ejection fraction and AF. This non-invasive technique can characterize and quantify the regional deformation of the left atrium, reflecting its compliance and potential fibrosis. It is composed of reservoir strain, conduit strain, and contraction strain. This technology has been investigated to predict successful response to AF ablation, its association with the presence of thrombus in the left atrial appendage, and the occurrence of incidental AF in patients with cryptogenic stroke. Objective: To compare left atrial strain in patients with atrial fibrillation before and after ablation. Methods: A prospective cohort study was conducted between June 2023 and January 2025 at the echocardiography department of Hospital Oto Aldeota, Fortaleza, Ceará, Brazil. Data were analyzed from patients referred to the service for transesophageal echocardiography prior to AF ablation. Multiple echocardiographic variables were assessed: j y S ’ ’ w k emptying velocity in the left atrial appendage, left atrial strain (reservoir, conduit, and contraction) in apical 4- and 2-chamber views. After three months, the same variables were obtained and compared. For the analysis of continuous variables with normal distribution, comparisons between two dependent groups were performed using the paired t-test. For non- normally distributed variables, the Wilcoxon test was applied, and the McNemar test was used for comparisons between categorical variables before and after ablation. Results: Thirty-nine patients with AF (61.5% paroxysmal AF and 38.5% persistent AF) were analyzed before and after ablation. A statistically significant increase was observed in reservoir, conduit, and contraction strain parameters after ablation and maintenance of sinus rhythm. Improvement in w w E/ ’ ’ w values, as well as reductions in left atrial volume and diameter and improvements in left ventricular global longitudinal strain values. Conclusion: Left atrial strain is a valuable tool in patients with AF, showing a marked improvement after restoration of sinus rhythm and increased values associated with reduced left atrial volume and improved diastolic function.