2D Speckle-Tracking Echocardiography Assessment of Left Atrial and Left Ventricular Mechanics: Outcomes in Patients with Atrial Fibrillation Treated with Hybrid Ablation and Left Atrial Appendage Surgical Closure

Andrea Maria Paparella ¹ Luigi Pannone ¹ Gianni Pedrizzetti ^2,3 Giacomo Talevi ¹ Domenico Giovanni Della Rocca ¹ Antonio Sorgente ¹ Rani Kronenberger ¹ GAETANO PAPARELLA ¹ Ingrid Overeinder ¹ Gezim Bala ¹ Alexandre Almorad ¹ Erwin Ströker ¹ Juan Sieira ¹ Mark La Meir ¹ Andrea Sarkozy ¹ Pedro Brugada ¹ Gian Battista Chierchia ¹ Ali Gharaviri ¹ Carlo de Asmundis ^1*

• ¹ Heart Rhythm Management Center, University Hospital Brussels, Brussels, Belgium
• ² Department of Engineering and Architecture, University of Trieste, Trieste, Friuli-Venezia Giulia, Italy
• ³ The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States

Background and aims: Hybrid atrial fibrillation (AF) ablation is a therapeutic option in non-paroxysmal AF. Our study examines cardiac mechanics changes after hybrid AF ablation plus epicardial closure of left atrial appendage (LAA).Methods: All consecutive patients undergoing hybrid AF ablation at UZ Brussel were evaluated. They received pulmonary vein isolation (PVI), posterior wall isolation (LAPWI), and epicardial LAA closure. LA and LV mechanics were analyzed, with the following measures obtained at baseline, post-ablation, and follow-up: 1) volumes (EDV, ESV); 2) ejection fraction (EF); 3) strain (ENDO GCS, ENDO GLS); 4) forces (LVLF, LVsysLF, LVim, LVs).Results: A total of 50 patients were included. At follow-up, LAEDV decreased from baseline [44.7 ml vs. 53.8 ml, P = 0.025]. LA ENDO GCS and GLS increased post-ablation, with further GLS improvement at follow-up. LV ENDO GCS and LV ENDO GLS also rose post-ablation [-26.7% vs. -22.5%, P < .001] and [-20.57% vs. -16.6%, P < .001], respectively. LVEF increased post-ablation [54.6% vs. 46.3%, P < .001]. There was an increase in all LV hemodynamic forces (HDFs) and in particular: LVLF and LVsysLF increased post-ablation [15.5% vs. 10.4%, P < .001] and [21.5% vs. 14.11%, P < .001], respectively. LVim also increased post-ablation [19.6% vs. 12.8%, P < .001]. Finally, there was an increase in LVs post-ablation compared to baseline [10.6% vs. 5.4%, P < .001]. Conclusions: In patients undergoing hybrid AF ablation, there was a significant and persistent improvement in the mechanical and hemodynamic functions of both LA and LV.