Comparative analysis of left atrium deformity using “speckle-tracking” echocardiography technology in patients after catheter, thoracoscopic, and hybrid ablation procedures

Aim : to perform a comprehensive comparative analysis of the dynamics of changes in the parameters of left atrial deformity according to “speckle-tracking” echocardiography in patients with nonparoxysmal forms of atrial fibrillation who underwent catheter, thoracoscopic and hybrid ablation procedures in the long-term follow-up period. Material and methods : The study included 268 patients with persistent and long-term persistent forms of AF. The patients were pseudorandomized into three study groups depending on the treatment method: 1) catheter ablation (n = 80), 2) thoracoscopic ablation (n = 126), 3) hybrid ablation (n = 62). The dynamics of changes in left atrial deformity was analyzed in all patients included in the study using “speckle-tracking” echocardiography technology before and 3, 6, 12, and 24 months after ablation procedures. The primary endpoint of the study was considered to be the maintenance of a stable sinus rhythm as a result of daily monitoring of the electrocardiogram during a three-year follow-up period. Results : In the hybrid atrial fibrillation treatment group, there was a marked improvement in the reservoir function of the left atrium during the two-year follow-up period. The rates of left atrial deformity in the conduction and contractile phases were higher in the catheter ablation group compared with isolated thoracoscopic ablation and hybrid treatment of arrhythmia. The overall effectiveness of all ablation procedures was 81.2% with an average follow-up period of 27.8 ± 12.4 months, and the best results of maintaining a stable sinus rhythm were recorded in the hybrid ablation group and amounted to 95.0%. Conclusion : The parameters of the left atrium deformity obtained using the “speckle-tracking” echocardiography technology reflect the functional state of the atrium after both endo- and epicardial ablation procedures and can be used in the future to predict the effectiveness of the presented ablation procedures. Hybrid ablation demonstrates the best long-term results in restoring the reservoir function of the left atrium and preventing the return of atrial tachyarrhythmias in patients with nonparoxysmal forms of atrial fibrillation.