Left-Atrial Strain Predicts Rhythm Outcome in Patients with Persistent Atrial Fibrillation Undergoing Left-Atrial Cryoablation during Minimally Invasive Endoscopic Mitral Valve Repair

Background: Left-atrial (LA) strain is a predictor for left-atrial function and is reduced in patients with atrial fibrillation. In patients with persistent- and long-standing persistent atrial fibrillation, many surgeons are reluctant to perform concomitant surgical ablation procedures.

We here evaluated the prognostic value of LA strain to predict rhythm outcome in patients with persistent AF undergoing left-atrial cryoablation concomitant to minimally invasive mitral valve repair.

Method: Between 01/2016 and 05/2019, a total of 51 patients with persistent atrial fibrillation underwent left-atrial cryoablation during minimally invasive mitral valve surgery. All patients received a complete left-atrial lesion set and LAA closure with Atriclip. Fourteen (27.5%) patients received additional tricuspid valve repair. All patients received a preoperative TTE with left-atrial and left-ventricular strain measurement. Preoperative LA and LV Strain analysis was correlated with postoperative rhythm outcome

Results: Mean patients age was 66 ± 9 years, 53% were male patients. No major ablation related complications occurred in any of the patients. Successful closure of the LAA was confirmed by intraoperative TOE in all patients. One-year survival rate was 96%. Freedom from AF at 12 months was 71%. Permanent pacemaker implantation rate was 4%. In patients with freedom from AF at 12 months’ follow-up, preoperative LA-strain values were statistically significant higher (12.4% ± 7.3% vs. 4.8% ± 3.3%, p = 0.008). Therefore, preoperative LA strain was a predictor for freedom from AF at 1-year follow-up. Preoperative LV strain value was not correlated with postoperative rhythm outcome.

Conclusion: LA strain is a valuable tool to predict rhythm outcome in patients with persistent atrial fibrillation undergoing concomitant surgical AF ablation. In future, LA strain might be a useful tool to guide decision making on ablation strategies in patients with persistent atrial fibrillation.

Publication History

Article published online:
03 February 2022