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Atrial fibrillation (AF) is the most common serious arrhythmia encountered in clinical practice, and accounts for approximately one-third of all hospitalizations for cardiac rhythm disturbances.1 Consequently, effective therapies for conversion of AF to, and maintenance of, sinus rhythm (SR) have been actively sought. Currently, catheter-based ablation techniques have been shown to be promising in the elimination of AF. However, a significant percentage of patients undergoing catheter ablation have recurrence of AF; in one recent study, only 64% of patients with paroxysmal and 45% of patients with persistent AF were AF-free at 12 months follow-up.2 Other groups have shown that with complete pulmonary vein and posterior left atrial (LA) isolation, up to 63% of chronic AF patients maintained SR at 2 years3. Therefore, there is a great interest in markers, either clinical, biological. or imaging-based, that can predict which patients will maintain SR after catheter ablation and which will revert back to AF.Schneider and colleagues measured tissue Doppler-based strain and strain rate—measures of the degree and rate of LA deformation, respectively—24 h before, 24 h after, and 3 months post-catheter based ablation in 118 patients with either persistent or paroxysmal AF.4 Using catheter-based pulmonary vein isolation employong a ‘double Lasso’ technique, SR was achieved immediately following the procedure in all patients. Of the 118 patients followed-up for a 3-month period after catheter ablation a total of 82 patients (69%) … *Corresponding author. Tel: +1 713 798 2608, Fax: +1 713 798 2751, Email: hishamd{at}bcm.edu

Atrial deformation: the key to maintenance of sinus rhythm in patients with atrial fibrillation?