Left atrial dyssynchrony time measured by tissue Doppler imaging to predict atrial fibrillation recurrences after pulmonary vein isolation

Objective: In this study we assess the value of left atrial dyssynchrony time measured by tissue Doppler imaging (TDI) to predict recurrences after pulmonary vein isolation (PVI) in patients with paroxysmal and persistent atrial fibrillation (AF). Methods: One hundred sixty patients (57 +/- 7.5 years, 122 males) with symptomatic drug-refractory paroxysmal and persistent AF, undergoing PVI were enrolled in our study. PA peak time by tissue Doppler imaging (PApeak-TDI) is defined as the time measured from the start of P wave in lead II to the peak of A wave on the tissue Doppler tracing. Left atrial dyssynchrony was measured by subtracting the PApeak-TDI time measured at the mid-inter atrial septum from the PA peak-TDI time measured at the left atrial midlateral free wall, (LA dyssynchrony=PApeak TDI lateral-PApeak TDI septal). Results: During a mean follow-up of 12 +/- 3 months, recurrences occurred in 50 out of 160 patients. Patients with recurrence of atrial fibrillation had larger left atrial dyssynchrony time (26.5 +/- 2.4 ms vs. 23.5 +/- 2.3 ms, p<0.001). Left atrial dyssynchrony time of 25 ms has the best combined sensitivity and specificity (74% and 63% respectively) along with positive predictive value 53% and negative predictive value 85.5%. LA dyssynchrony time >= 25 ms was found to discriminate patients prone to AF recurrences over time. Multivariate regression analysis showed that left atrial dyssynchrony time (HR per ms: 1.69, p<0.001) was identified as independent predictor of AF recurrence. Conclusion: Left atrial dyssynchrony time is good clinical predictor of recurrence of AF after PVI in patients with paroxysmal and persistent AF.