Left atrial deformation predicts success of first and second percutaneous atrial fibrillation ablation Sílvia Montserrat, MD,* † Luigi Gabrielli, MD, ‡ Bart Bijnens, PhD, § Roger Borràs, BSc,* † Antonio Berruezo, MD, PhD,* † Sílvia Poyatos, RN,* † Josep Brugada, MD, PhD,* † Lluis Mont, MD, PhD,* † Marta Sitges, MD, PhD* † From the * Cardiology Department, Thorax Institute, Hospital Clinic, † IDIBAPS, University of Barcelona, Barcelona, Spain, ‡ Advanced Center for Chronic Diseases, Pontificia Universidad Católica de Chile, Comisión Nacional de Ciencia y Tecnologia FONDAP and § ICREA–Universitat Pompeu Fabra, Barcelona, Spain, and IDIBAPS–Institut d’Investigacions Biomèdiques August Pi i Sunyer. BACKGROUND Predictors of second radiofrequency catheter abla- tion (RFCA) success are not well known. Surgical ablation is accepted for failed first RFCA, but second RFCA has fewer complications. OBJECTIVE The purpose of this study was to evaluate left atrial (LA) size and function as potential predictors of second RFCA for atrial fibrillation (AF). METHODS Thirty-three healthy volunteers (group I) and 83 patients with symptomatic drug-refractory AF treated with a first RFCA (group II, n ¼ 48) or a second RFCA (group III, n ¼ 35 patients) were included. Echocardiography was performed in all patients in sinus rhythm before RFCA and in all volunteers. LA size and function were measured using longi- tudinal strain and strain rate during ventricular systole (LASs, LASRs) and during early diastole (LASRe) or late diastole (LASRa) with speckle tracking echocardiography. The effective- ness of RFCA on arrhythmia recurrence was evaluated at 6- month follow-up. RESULTS LASs, LASRs, and LASRa were significantly lower in group III patients compared to other groups (P o .001 for all). LA diameter or volumes did not predict success after RFCA. LASs was an independent predictor of arrhythmia suppression after a first RFCA and after a second RFCA, with the best cutoff at LASs 420% (sensitivity 86%, specificity 70%) and LASs 412% (sensitivity 84%, specificity 90%), respectively. CONCLUSION LA myocardial deformation imaging is a reliable tool for predicting success after a first and a second RFCA. These parameters could improve candidate selection, especially for a second RFCA. KEYWORDS Atrial fibrillation; Atrial function; Second catheter ablation; Predictors; Strain; Strain rate ABBREVIATIONS AF ¼ atrial fibrillation; LA ¼ left atrial; LASRa ¼ longitudinal left atrial late diastole strain rate with speckle tracking; LASRe ¼ longitudinal left atrial early diastole strain rate with speckle tracking; LASRs ¼ longitudinal left atrial systolic strain rate with speckle tracking; LASs ¼ longitudinal left atrial systolic strain with speckle tracking; LV ¼ left ventricle; RFCA ¼ radiofrequency catheter ablation; ROC ¼ receiver operating characteristic; ST ¼ speckle tracking (Heart Rhythm 2015;12:11–18) I 2015 Heart Rhythm Society. All rights reserved. Introduction Radiofrequency catheter ablation (RFCA) has become an important alternative for the treatment of patients with symptomatic drug-refractory atrial fibrillation (AF). 1,2 How- ever, potential—albeit infrequent—complications of the procedure and the arrhythmia recurrence rate warrant careful selection of candidates for RFCA. 3 Enlarged left atrium (LA) 4–9 has been related to AF recurrence after a first RFCA procedure, and LA function assessed by 3-dimensional echocardiography is a predictor of success in eliminating the arrhythmia after a first RFCA procedure. 10 Despite improved RFCA success with repeated proce- dures, predictors of arrhythmia suppression after a second RFCA procedure are not known. 11 In a previous study, LA size and LA function assessed by 3-dimensional echocar- diography failed to predict AF recurrence after a second RFCA. 10 Myocardial deformation imaging derived from speckle tracking (ST) represents a novel tool for evaluating LA performance. 12–14 Accordingly, the aim of the present study was to analyze LA function with myocardial deformation imaging in patients before a first or second RFCA procedure and to Address reprint requests and correspondence: Dr. Marta Sitges, Cardi- ology Department, Thorax Institute, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain. E-mail address: msitges@clinic.ub.es. 1547-5271/$-see front matter B 2015 Heart Rhythm Society. All rights reserved. http://dx.doi.org/10.1016/j.hrthm.2014.08.032