Vol 27, No 6 (2020)
Review Article
Published online: 2020-05-16

open access

Page views 2755
Article views/downloads 2184
Get Citation

Connect on Social Media

Connect on Social Media

Echocardiographic predictors of atrial fibrillation recurrence after catheter ablation: A literature review

Aleksandra Liżewska-Springer1, Alicja Dąbrowska-Kugacka1, Ewa Lewicka1, Łukasz Drelich1, Tomasz Królak1, Grzegorz Raczak1
Pubmed: 29924375
Cardiol J 2020;27(6):848-856.


Background: Catheter ablation (CA) is a well-known treatment option for patients with symptomatic drug-resistant atrial fibrillation (AF). Multiple factors have been identified to determine AF recurrence after CA, however their predictive value is rather small. Identification of novel predictors of CA outcome is therefore of primary importance to reduce health costs and improve long-term results of intervention. The recurrence of AF following CA is related to severity of left ventricular (LV) dysfunction, extent of atrial dilatation and fibrosis. The aim of this paper was to present and discuss the latest studies on the utility of echocardiographic parameters in terms of CA effectiveness in patients with paroxysmal and persistent AF.

Methods: PubMed, Google Scholar, EBSCO databases were searched for studies reporting echocardiographic preprocedural predictors of AF recurrence after CA. LV systolic and diastolic function, as well as atrial size, strain and dyssynchrony were taken into consideration.

Results: Twenty one full-text articles were analyzed, including three meta-analyses. Several echocardiographic parameters have been reported to determine a risk of AF recurrence after CA. There are conventional methods that measure left atrial size and volume, LV ejection fraction, parameters assessing LV diastolic dysfunction, and methods using more innovative technologies based on speckle tracking echocardiography to determine left atrial synchrony and strain. Each of these parameters has its own predictive value.

Conclusions: Regarding CA effectiveness, every patient has to be evaluated individually to estimate the risk of AF recurrence, optimally using a combination of several echocardiographic parameters.

Article available in PDF format

View PDF Download PDF file


  1. Kirchhof P, Benussi S, Kotecha D, et al. ESC Scientific Document Group . 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016; 37(38): 2893–2962.
  2. Vizzardi E, Curnis A, Latini MG, et al. Risk factors for atrial fibrillation recurrence: a literature review. J Cardiovasc Med (Hagerstown). 2014; 15(3): 235–253.
  3. Burstein B, Nattel S. Atrial fibrosis: mechanisms and clinical relevance in atrial fibrillation. J Am Coll Cardiol. 2008; 51(8): 802–809.
  4. Vaziri SM, Larson MG, Benjamin EJ, et al. Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study. Circulation. 1994; 89(2): 724–730.
  5. Berruezo A, Tamborero D, Mont L, et al. Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation. Eur Heart J. 2007; 28(7): 836–841.
  6. Calkins H, Kuck K, Cappato R, et al. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design. Heart Rhythm. 2012; 9(4): 632–696.e21.
  7. Cameli M, Lisi M, Righini FM, et al. Usefulness of atrial deformation analysis to predict left atrial fibrosis and endocardial thickness in patients undergoing mitral valve operations for severe mitral regurgitation secondary to mitral valve prolapse. Am J Cardiol. 2013; 111(4): 595–601.
  8. Zhuang J, Wang Y, Tang K, et al. Association between left atrial size and atrial fibrillation recurrence after single circumferential pulmonary vein isolation: a systematic review and meta-analysis of observational studies. Europace. 2011; 14(5): 638–645.
  9. Liao YC, Liao JN, Lo LW, et al. Left Atrial Size and Left Ventricular End-Systolic Dimension Predict the Progression of Paroxysmal Atrial Fibrillation After Catheter Ablation. J Cardiovasc Electrophysiol. 2017; 28(1): 23–30.
  10. Tomas L, Orosco A, Vergara JM, et al. Predictors of recurrence and outcomes in catheter ablation of paroxysmal atrial fibrillation. Rev Argent Cardiol. 2017; 85(3): 240–246.
  11. Njoku A, Kannabhiran M, Arora R, et al. Left atrial volume predicts atrial fibrillation recurrence after radiofrequency ablation: a meta-analysis. Europace. 2018; 20(1): 33–42.
  12. Shin SH, Park MY, Oh WJ, et al. Left atrial volume is a predictor of atrial fibrillation recurrence after catheter ablation. J Am Soc Echocardiogr. 2008; 21(6): 697–702.
  13. Moon J, Hong YJ, Shim J, et al. Right atrial anatomical remodeling affects early outcomes of nonvalvular atrial fibrillation after radiofrequency ablation. Circulation . 2012; 76(4): 860–867.
  14. Wen SN, Liu N, Bai R, et al. Right atrial diameter and outcome of catheter ablation of atrial fibrillation. J Interv Card Electrophysiol. 2017; 49(2): 157–164.
  15. Di Biase L, Mohanty P, Mohanty S, et al. Ablation versus amiodarone for treatment of persistent atrial fibrillation in patients with congestive heart failure and an implanted device: results from the AATAC multicenter randomized trial. Circulation. 2016; 133(17): 1637–1644.
  16. Black-Maier E, Ren X, Steinberg BA, et al. Catheter ablation of atrial fibrillation in patients with heart failure and preserved ejection fraction. Heart Rhythm. 2018; 15(5): 651–657.
  17. Melenovsky V, Hwang SJ, Redfield MM, et al. Left atrial remodeling and function in advanced heart failure with preserved or reduced ejection fraction. Circ Heart Fail. 2015; 8(2): 295–303.
  18. Cha YM, Wokhlu A, Asirvatham SJ, et al. Success of ablation for atrial fibrillation in isolated left ventricular diastolic dysfunction: a comparison to systolic dysfunction and normal ventricular function. Circ Arrhythm Electrophysiol. 2011; 4(5): 724–732.
  19. Marrouche NF, Brachmann J, Andresen D, et al. Catheter ablation for atrial fibrillation with heart failure. N Engl J Med. 2018; 378(5): 417–427.
  20. Hu YF, Hsu TL, Yu WC, et al. The impact of diastolic dysfunction on the atrial substrate properties and outcome of catheter ablation in patients with paroxysmal atrial fibrillation. Circulation. 2010; 74(10): 2074–2078.
  21. Park J, Joung B, Uhm JS, et al. High left atrial pressures are associated with advanced electroanatomical remodeling of left atrium and independent predictors for clinical recurrence of atrial fibrillation after catheter ablation. Heart Rhythm. 2014; 11(6): 953–960.
  22. Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016; 29(4): 277–314.
  23. Hirai T, Cotseones G, Makki N, et al. Usefulness of left ventricular diastolic function to predict recurrence of atrial fibrillation in patients with preserved left ventricular systolic function. Am J Cardiol. 2014; 114(1): 65–69.
  24. Masuda M, Fujita M, Iida O, et al. An E/e' ratio on echocardiography predicts the existence of left atrial low-voltage areas and poor outcomes after catheter ablation for atrial fibrillation. Europace. 2018; 20(5): e60–e68.
  25. Okamatsu H, Ohara T, Kanzaki H, et al. Impact of left ventricular diastolic dysfunction on outcome of catheter ablation for atrial fibrillation in patients with hypertrophic cardiomyopathy. Circ J. 2015; 79(2): 419–424.
  26. Onishi N, Kaitani K, Amano M, et al. Relationship between left ventricular diastolic dysfunction and very late recurrences after multiple procedures for atrial fibrillation ablation. Heart Vessels. 2018; 33(1): 41–48.
  27. Kosiuk J, Breithardt OA, Bode K, et al. The predictive value of echocardiographic parameters associated with left ventricular diastolic dysfunction on short- and long-term outcomes of catheter ablation of atrial fibrillation. Europace. 2014; 16(8): 1168–1174.
  28. Ouyang F, Antz M, Ernst S, et al. Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double Lasso technique. Circulation. 2005; 111(2): 127–135.
  29. Sauer WH, McKernan ML, Lin D, et al. Clinical predictors and outcomes associated with acute return of pulmonary vein conduction during pulmonary vein isolation for treatment of atrial fibrillation. Heart Rhythm. 2006; 3(9): 1024–1028.
  30. Schneider C, Malisius R, Krause K, et al. Strain rate imaging for functional quantification of the left atrium: atrial deformation predicts the maintenance of sinus rhythm after catheter ablation of atrial fibrillation. Eur Heart J. 2008; 29(11): 1397–1409.
  31. Hammerstingl C, Schwekendiek M, Momcilovic D, et al. Left atrial deformation imaging with ultrasound based two-dimensional speckle-tracking predicts the rate of recurrence of paroxysmal and persistent atrial fibrillation after successful ablation procedures. J Cardiovasc Electrophysiol. 2012; 23(3): 247–255.
  32. Mirza M, Caracciolo G, Khan U, et al. Left atrial reservoir function predicts atrial fibrillation recurrence after catheter ablation: a two-dimensional speckle strain study. J Interv Card Electrophysiol. 2011; 31(3): 197–206.
  33. Kuppahally SS, Akoum N, Burgon NS, et al. Left atrial strain and strain rate in patients with paroxysmal and persistent atrial fibrillation: relationship to left atrial structural remodeling detected by delayed-enhancement MRI. Circ Cardiovasc Imaging. 2010; 3(3): 231–239.
  34. Ma XX, Boldt LH, Zhang YL, et al. Clinical relevance of left atrial strain to predict recurrence of atrial fibrillation after catheter ablation: a meta-analysis. Echocardiography. 2016; 33(5): 724–733.
  35. Yasuda R, Murata M, Roberts R, et al. Left atrial strain is a powerful predictor of atrial fibrillation recurrence after catheter ablation: study of a heterogeneous population with sinus rhythm or atrial fibrillation. Eur Heart J Cardiovasc Imaging. 2015; 16(9): 1008–1014.
  36. Parwani AS, Morris DA, Blaschke F, et al. Left atrial strain predicts recurrence of atrial arrhythmias after catheter ablation of persistent atrial fibrillation. Open Heart. 2017; 4(1): e000572.
  37. Mochizuki A, Yuda S, Oi Y, et al. Assessment of left atrial deformation and synchrony by three-dimensional speckle-tracking echocardiography: comparative studies in healthy subjects and patients with atrial fibrillation. J Am Soc Echocardiogr. 2013; 26(2): 165–174.
  38. Kobayashi Y, Okura H, Kobayashi Y, et al. Assessment of atrial synchrony in paroxysmal atrial fibrillation and impact of pulmonary vein isolation for atrial dyssynchrony and global strain by three-dimensional strain echocardiography. J Am Soc Echocardiogr. 2014; 27(11): 1193–1199.
  39. Mochizuki A, Yuda S, Fujito T, et al. Left atrial strain assessed by three-dimensional speckle tracking echocardiography predicts atrial fibrillation recurrence after catheter ablation in patients with paroxysmal atrial fibrillation. J Echocardiogr. 2017; 15(2): 79–87.
  40. Loghin C, Karimzadehnajar K, Ekeruo IA, et al. Outcome of pulmonary vein isolation ablation for paroxysmal atrial fibrillation: predictive role of left atrial mechanical dyssynchrony by speckle tracking echocardiography. J Interv Card Electrophysiol. 2014; 39(1): 7–15.
  41. den Uijl DW, Gawrysiak M, Tops LF, et al. Prognostic value of total atrial conduction time estimated with tissue Doppler imaging to predict the recurrence of atrial fibrillation after radiofrequency catheter ablation. Europace. 2011; 13(11): 1533–1540.
  42. Erdem FH, Erdem A, Özlü F, et al. Electrophysiological validation of total atrial conduction time measurement by tissue doppler echocardiography according to age and sex in healthy adults. J Arrhythm. 2016; 32(2): 127–132.
  43. Fukushima K, Fukushima N, Ejima K, et al. Left atrial appendage flow velocity and time from P-wave onset to tissue Doppler-derived A' predict atrial fibrillation recurrence after radiofrequency catheter ablation. Echocardiography. 2015; 32(7): 1101–1108.
  44. Evranos B, Aytemir K, Oto A, et al. Predictors of atrial fibrillation recurrence after atrial fibrillation ablation with cryoballoon. Cardiol J. 2013; 20(3): 294–303.
  45. Sarvari SI, Haugaa KH, Stokke TM, et al. Strain echocardiographic assessment of left atrial function predicts recurrence of atrial fibrillation. Eur Heart J Cardiovasc Imaging. 2016; 17(6): 660–667.
  46. Qiao Yu, Wu L, Hou B, et al. Functional mitral regurgitation: predictor for atrial substrate remodeling and poor ablation outcome in paroxysmal atrial fibrillation. Medicine (Baltimore). 2016; 95(30): e4333.