Echocardiographic Assessment of Left Atrial Function for Prediction of Efficacy of Catheter Ablation for Atrial Fibrillation

Background: Atrial fibrillation (AF) is among the most frequently encountered cardiac arrhythmias, exerting a significant burden on both primary and secondary healthcare services. This aimed to evaluate the utility of detailed LA functional assessment via Speckle tracking echocardiography (STE) in cases with non-valvular AF without structural heart disease, especially in those without enlarged LA, in predicting the outcome after catheter ablation (CA) for atrial fibrillation. Methods: This prospective cohort investigation enrolled 36 cases with non-valvular AF eligible for CA. All participants underwent transthoracic echocardiography, including conventional imaging, Doppler assessment, and STE, followed by CA. Results: LA speckle tracking analysis proved valuable in identifying appropriate candidates for CA among cases with AF and normal findings on conventional echocardiography. Age, LVEF, LAVI, GLASr, and GLASct emerged as independent predictors of successful CA, while LAD, LAstf, GLAScd, GLASRr, and GLASRct did not. LAVI and GLASr significantly predicted CA success at thresholds >30 ml/m² and >25.2, respectively (P < 0.001), with sensitivity of 88.24% and 100%, specificity of 94.74% for both, PPV of 93.7% and 94.4%, NPV of 90% and 100%, and AUCs of 0.981 and 0.969, respectively. Conclusion: LA speckle tracking analysis is a valuable tool for selecting candidates for CA in AF cases without structural heart disease and with unremarkable conventional echocardiographic findings. Age, LVEF, LAVI, GLASr, and GLASct serve as independent predictors of CA efficacy, whereas LAD, LAstf, GLAScd, GLASRr, and GLASRct do not. This is especially relevant in cases without LA enlargement, no structural cardiac abnormalities, and undergoing first-time CA.