Right atrial strain in atrial fibrillation: the hidden side of the moon
IntroductionLeft atrial (LA) remodeling in atrial fibrillation (AF) is well studied, whereas right atrial (RA) alterations remain poorly characterized. This study evaluates bi-atrial strain dynamics in patients with AF undergoing catheter ablation (CA).MethodsA total of 56 consecutive patients under...
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Frontiers Media S.A.
2025-05-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1578524/full |
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| author | Eleonora Ruscio Francesca Augusta Gabrielli Gaetano Pinnacchio Francesco Raffaele Spera Francesco Raffaele Spera Federica Giordano Federica Giordano Roberto Scacciavillani Maria Lucia Narducci Maria Lucia Narducci Gianluigi Bencardino Francesco Perna Filippo Crea Filippo Crea Gemma Pelargonio Gemma Pelargonio |
| author_facet | Eleonora Ruscio Francesca Augusta Gabrielli Gaetano Pinnacchio Francesco Raffaele Spera Francesco Raffaele Spera Federica Giordano Federica Giordano Roberto Scacciavillani Maria Lucia Narducci Maria Lucia Narducci Gianluigi Bencardino Francesco Perna Filippo Crea Filippo Crea Gemma Pelargonio Gemma Pelargonio |
| author_sort | Eleonora Ruscio |
| collection | DOAJ |
| description | IntroductionLeft atrial (LA) remodeling in atrial fibrillation (AF) is well studied, whereas right atrial (RA) alterations remain poorly characterized. This study evaluates bi-atrial strain dynamics in patients with AF undergoing catheter ablation (CA).MethodsA total of 56 consecutive patients undergoing AF ablation were prospectively evaluated using speckle-tracking echocardiography and electrophysiological study before and after CA (median follow-up: 7 ± 3 months). A control group of 32 individuals undergoing CA for paroxysmal atrioventricular nodal reentrant tachycardia, without structural heart disease, was included for comparison.ResultsCompared to controls, AF patients exhibited significantly lower RA strain parameters (right atrial peak strain, reservoir phase, pRASr: 22.1 ± 12.6% vs. 29.8 ± 12.7%, p = 0.009) and greater RA mechanical dispersion (defined as the standard deviation of the time-to-peak positive strain, from the three RA segments, corrected for R-R interval, SD-regional-RA-TTP-N: 0.048 ± 0.015 vs. 0.038 ± 0.009, p = 0.020). Patients with persistent AF demonstrated a more pronounced RA dysfunction than those with paroxysmal AF (pRASr: 15.9 ± 11.7% vs. 24.8 ± 12.1%, p = 0.017; SD-regional-RA-TTP-N: 0.062 ± 0.030 vs. 0.043 ± 0.023, p = 0.016), despite comparable LA strain values. RA function correlated with both LA strain and volume parameters, and with the extent of abnormal LA electroanatomical substrate (pRASr and left atrial peak strain, reservoir phase, pLASr: r = 0.594, p < 0.001; pRASr and low-voltage LA area: r = −0.316, p = 0.018). Notably, RA parameters, rather than LA indices, were significantly reduced in patients with post-ablation AF recurrence (pRASr: 14.1 ± 11.7% vs. 24.6 ± 13.5%, p = 0.039; SD-regional-RA-TTP-N: 0.054 ± 0.031 vs. 0.032 ± 0.010, p = 0.002). However, the CHA2DS2-VASc score remained the sole independent predictor of AF recurrence (HR 1.47, 95% CI 1.003–2.158, p = 0.048).ConclusionRA function, assessed through strain imaging, was progressively impaired in more severe AF subtypes, strongly correlating with bi-atrial mechanical and electroanatomical properties. Furthermore, RA function was associated with AF recurrence after catheter ablation, highlighting its potential prognostic value. |
| format | Article |
| id | doaj-art-48ab89b5e6064802809155c39f33f4be |
| institution | OA Journals |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-48ab89b5e6064802809155c39f33f4be2025-08-20T02:17:08ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-05-011210.3389/fcvm.2025.15785241578524Right atrial strain in atrial fibrillation: the hidden side of the moonEleonora Ruscio0Francesca Augusta Gabrielli1Gaetano Pinnacchio2Francesco Raffaele Spera3Francesco Raffaele Spera4Federica Giordano5Federica Giordano6Roberto Scacciavillani7Maria Lucia Narducci8Maria Lucia Narducci9Gianluigi Bencardino10Francesco Perna11Filippo Crea12Filippo Crea13Gemma Pelargonio14Gemma Pelargonio15Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, ItalyDepartment of Clinical and Molecular Medicine, Sapienza University, Rome, ItalyCardiology Department, Sant'Andrea University Hospital, Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, ItalyCardiothoracic Department, University Hospital Santa Maria Della Misericordia, Udine, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, ItalyCardiology Institute, Catholic University of Sacred Heart, Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, ItalyCenter of Excellence of Cardiovascular Sciences, Ospedale Isola Tiberina—Gemelli Isola, Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, ItalyCardiology Institute, Catholic University of Sacred Heart, Rome, ItalyIntroductionLeft atrial (LA) remodeling in atrial fibrillation (AF) is well studied, whereas right atrial (RA) alterations remain poorly characterized. This study evaluates bi-atrial strain dynamics in patients with AF undergoing catheter ablation (CA).MethodsA total of 56 consecutive patients undergoing AF ablation were prospectively evaluated using speckle-tracking echocardiography and electrophysiological study before and after CA (median follow-up: 7 ± 3 months). A control group of 32 individuals undergoing CA for paroxysmal atrioventricular nodal reentrant tachycardia, without structural heart disease, was included for comparison.ResultsCompared to controls, AF patients exhibited significantly lower RA strain parameters (right atrial peak strain, reservoir phase, pRASr: 22.1 ± 12.6% vs. 29.8 ± 12.7%, p = 0.009) and greater RA mechanical dispersion (defined as the standard deviation of the time-to-peak positive strain, from the three RA segments, corrected for R-R interval, SD-regional-RA-TTP-N: 0.048 ± 0.015 vs. 0.038 ± 0.009, p = 0.020). Patients with persistent AF demonstrated a more pronounced RA dysfunction than those with paroxysmal AF (pRASr: 15.9 ± 11.7% vs. 24.8 ± 12.1%, p = 0.017; SD-regional-RA-TTP-N: 0.062 ± 0.030 vs. 0.043 ± 0.023, p = 0.016), despite comparable LA strain values. RA function correlated with both LA strain and volume parameters, and with the extent of abnormal LA electroanatomical substrate (pRASr and left atrial peak strain, reservoir phase, pLASr: r = 0.594, p < 0.001; pRASr and low-voltage LA area: r = −0.316, p = 0.018). Notably, RA parameters, rather than LA indices, were significantly reduced in patients with post-ablation AF recurrence (pRASr: 14.1 ± 11.7% vs. 24.6 ± 13.5%, p = 0.039; SD-regional-RA-TTP-N: 0.054 ± 0.031 vs. 0.032 ± 0.010, p = 0.002). However, the CHA2DS2-VASc score remained the sole independent predictor of AF recurrence (HR 1.47, 95% CI 1.003–2.158, p = 0.048).ConclusionRA function, assessed through strain imaging, was progressively impaired in more severe AF subtypes, strongly correlating with bi-atrial mechanical and electroanatomical properties. Furthermore, RA function was associated with AF recurrence after catheter ablation, highlighting its potential prognostic value.https://www.frontiersin.org/articles/10.3389/fcvm.2025.1578524/fullatrial fibrillationstrain imagingechocardiographyatrial cardiomyopathycatheter ablation |
| spellingShingle | Eleonora Ruscio Francesca Augusta Gabrielli Gaetano Pinnacchio Francesco Raffaele Spera Francesco Raffaele Spera Federica Giordano Federica Giordano Roberto Scacciavillani Maria Lucia Narducci Maria Lucia Narducci Gianluigi Bencardino Francesco Perna Filippo Crea Filippo Crea Gemma Pelargonio Gemma Pelargonio Right atrial strain in atrial fibrillation: the hidden side of the moon Frontiers in Cardiovascular Medicine atrial fibrillation strain imaging echocardiography atrial cardiomyopathy catheter ablation |
| title | Right atrial strain in atrial fibrillation: the hidden side of the moon |
| title_full | Right atrial strain in atrial fibrillation: the hidden side of the moon |
| title_fullStr | Right atrial strain in atrial fibrillation: the hidden side of the moon |
| title_full_unstemmed | Right atrial strain in atrial fibrillation: the hidden side of the moon |
| title_short | Right atrial strain in atrial fibrillation: the hidden side of the moon |
| title_sort | right atrial strain in atrial fibrillation the hidden side of the moon |
| topic | atrial fibrillation strain imaging echocardiography atrial cardiomyopathy catheter ablation |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1578524/full |
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