Opinion Review
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2022; 10(23): 8063-8075
Published online Aug 16, 2022. doi: 10.12998/wjcc.v10.i23.8063
Clinical utility of left atrial strain in predicting atrial fibrillation recurrence after catheter ablation: An up-to-date review
Zhi-Xi Yu, Wen Yang, Wei-Si Yin, Ke-Xin Peng, Yi-Lin Pan, Wei-Wei Chen, Bei-Bei Du, Yu-Quan He, Ping Yang
Zhi-Xi Yu, Wen Yang, Wei-Si Yin, Ke-Xin Peng, Yi-Lin Pan, Wei-Wei Chen, Bei-Bei Du, Ping Yang, Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun 130022, Jilin Province, China
Yu-Quan He, Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
Author contributions: Yu ZX, Yang W, and Yin WS conceptualized the study and wrote the original draft; Peng KX, Pan YL, and Chen WW helped with literature acquisition and data validation; Du BB edited the manuscript; Du BB, He YQ, and Yang P helped with the revision and finalization of the manuscript; all authors issued final approval for the version to be submitted.
Supported by the Young Scientist Fund of the National Natural Science Foundation of China, No. 82100337; and Jilin Provincial Science and Technology Department, No. 20210402016GH.
Conflict-of-interest statement: The authors declare no conflict of interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bei-Bei Du, MD, PhD, Department of Cardiology, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun 130031, Jilin Province, China. beibeidu2012@jlu.edu.cn
Received: March 22, 2022
Peer-review started: March 22, 2022
First decision: May 30, 2022
Revised: June 3, 2022
Accepted: July 18, 2022
Article in press: July 18, 2022
Published online: August 16, 2022
Processing time: 131 Days and 14.4 Hours
Abstract

Rhythm control is the core part of the integrated management of atrial fibrillation (AF), especially in the early stages. Despite advances in catheter ablation (CA), the recurrence rate of AF after CA remains high. As a result, stratification and early management of AF recurrence after CA are critical. Currently, predictors of recurrence of AF after CA are mostly based on dysfunction caused by structural remodeling, apart from traditional risk factors. Atrial strain is a recently developed important parameter for detecting the deformability of atrial myocardium during the cardiac cycle prior to atrial remodeling. Although there is only preliminary evidence, atrial strain is still a promising parameter in predicting the recurrence of AF after CA at an early stage. This review focuses on the evaluation of atrial strain, the current applications of atrial strain in assessing atrial function, and predicting the recurrence of AF after CA. We summarize the contents related as follows: (1) CA for rhythm control in AF; (2) Evaluation methods of atrial strain; (3) Atrial strain in the remodeling and reverse remodeling of AF; and (4) Clinical applications of atrial strain in predicting the recurrence of AF after CA. Although there is accumulating evidence on the role of decreased atrial strain in the early prediction of AF recurrence, atrial strain is limited in clinical practice for lacking exact cut-off values and difficulty in distinguishing specific function phases of the atrium. More research is needed in the future to add strength to the early prediction value of atrial strain in AF recurrences.

Keywords: Atrial strain; Atrial remodeling; Speckle tracking image; Catheter ablation; Atrial fibrillation recurrence

Core Tip: Atrial fibrillation (AF) is the most common arrhythmia, and rhythm control, especially catheter ablation (CA) is the core part of the integrated management of AF. Despite protocol and devices advances in CA, the recurrence rate of AF after CA is still high. Atrial strain, the parameter of atrial deformation during the cardiac cycle, is closely related to atrial remodeling and atrial function. Furthermore, accumulating evidence showed the role of decreased atrial strain in the early prediction of AF recurrence. Further studies are needed to add strength to the early prediction value of atrial strain in AF recurrences.