Three-Dimensional Left Atrial Reservoir Function During Sinus Rhythm Can Discriminate Between a History of Paroxysmal Atrial Fibrillation and its Absence.

Background: Atrial fibrillation (AF) is the most common arrhythmia and can lead in the long-term to atrial remodelling. Three-dimensional speckle-tracking echocardiography allows evaluation of left atrial function and the magnitude of remodelling processes.

Methods: Echocardiography loops were collected between December 2021 and December 2022. Only valid atrial loops with sinus rhythm during examination were included. The Spearman test was used to establish correlation matrices of left atrial parameters, with uni-, multivariate and binary logistic regression to predict the presence or absence of AF.

Results: A total of 116 patients (50% females) aged 76.9 ± 11.2 years were included in the analysis. Males and females differed in anthropometric and other clinical parameters. Intra- and interobserver variability was 1.12% and 1.85%, respectively. 2D and 3D left atrial volumes correlated significantly (r = .8, P<.0001). Almost all left atrium strain measurements uni- and multivariately predicted the presence of AF, binary logistic regression model identified 2 independent parameters, left atrial longitudinal strain reservoir (LASr, P = .042) and LAS conduit phase (P = .044). LASr was significantly greater in patients without a history of AF than in patient with a history of AF (16 ± 16 and 10.5 ± 7.1, respectively; P = .012). LASr was able to discriminate between a history of paroxysmal AF and its absence with 72% specificity and 68% sensitivity with a cut-off value of 14% (AUC 0.72, 95% CI 0.62-0.82, P < .0001).

Conclusions: Three-dimensional left atrial reservoir function can differentiate patients with paroxysmal AF from patients without a history of this arrhythmia.