ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1578524
Right atrial strain in atrial fibrillation: the hidden side of the moon
Provisionally accepted- 1Department of Cardiovascular Sciences, Agostino Gemelli University Polyclinic (IRCCS), Rome, Lazio, Italy
- 2Department of Clinical and Molecular Medicine – Sapienza University, Rome, Italy
- 3Cardiology Department, Sant'Andrea University Hospital, Rome, Sicily, Italy
- 4Cardiothoracic Department, University Hospital Santa Maria della Misericordia, Udine, Italy
- 5Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
- 6Center of Excellence of Cardiovascular Sciences, Ospedale Isola Tiberina - Gemelli Isola, Rome, Italy
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Introduction: Left atrial (LA) remodelling in atrial fibrillation (AF) is well studied, whereas right atrial (RA) alterations remain poorly characterized. This study evaluates bi-atrial strain dynamics in AF patients undergoing catheter ablation (CA).Methods: A 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. Results: Compared to controls, AF patients exhibited significantly lower RA strain parameters (RA strain, pRASr: 22.1±12.6% vs. 29.8±12.7%, p=0.009) and greater RA mechanical dispersion (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, as well as with the extent of abnormal LA electroanatomical substrate (pRASr and 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, CI 1.003-2.158, p=0.048). Conclusion: RA 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.
Keywords: Atrial Fibrillation, strain imaging, Echocardiography, Atrial cardiomyopathy, Catheter Ablation
Received: 04 Mar 2025; Accepted: 17 Apr 2025.
Copyright: © 2025 Ruscio, Gabrielli, Pinnacchio, Spera, Giordano, Narducci, Bencardino, Perna, Crea and Pelargonio. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Gaetano Pinnacchio, Department of Cardiovascular Sciences, Agostino Gemelli University Polyclinic (IRCCS), Rome, 00168, Lazio, Italy
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