The role of left atrial peak systolic strain in atrial fibrillation recurrence after catheter ablation. A systematic review and meta-analysis

Background This systematic review and meta-analysis was performed to assess the prognostic role of left atrial peak systolic longitudinal strain (LA-PLSsys) as a predictor of atrial fibrillation (AF) recurrence after catheter ablation. Methods We systematically searched major electronic databases and grey literature for studies assessing the role of pre-ablation LA-PLSsys, measured in at least two segments, in post-ablation AF recurrence, after a follow-up period of at least 6 months. Results Seventeen eligible studies were included, resulting in 1704 patients (68.6% men) with a pooled mean age of 59.9 +/- 10.6 years, 65.9% with paroxysmal AF. Recurrence occurred in 32.7% of patients. Those without recurrence had significantly higher LA-PLSsys (pooled mean +/- SD: 22.22 +/- 10.64%, weighted mean difference: 5.43%, 95%CI: 4.03-6.84%, I-2: 82.7%). Subgroup analysis revealed that the methodology used (echocardiographic view and segments assessed), was a significant source of heterogeneity (p = 0.02). Meta-regression analysis demonstrated that the effect size was inversely related to the baseline LA volume index (p = 0.004), while concerns are also raised about patients with extremely high/low pre-ablation LA strain. Conclusions Pre-ablation LA-PLSsys seems to be a useful predictor of post-ablation AF recurrence, that could optimise patients selection. Nevertheless, the substantial heterogeneity that was noted may limit its clinical use. Further investigation using a uniform methodological assessment technique is required to derive a reference range, with adequate positive and negative predictive value for recurrence.