#1825 Monitoring of atrial indicators in patients with chronic kidney disease and atrial fibrillation after radio-frequency ablation

Abstract Background and Aims Left atrial (LA) strain is a predictor of the effectiveness of radio-frequency ablation (RFA). This treatment of atrial fibrillation (AF) in chronic kidney disease (CKD) patients leads to the development of the LA post ablation dysfunction with inhibition of all components of the deformation, which may cause the development of paroxysms of atrial tachyarrhythmia and thrombus formation in the early postoperative period. The aim is to evaluate atrial dynamic changes in patients with CKD stage III and AF after RFA. Method The study involved 114 CKD stage 3 patients with AF, who were divided according to the form of AF into the following groups: group with paroxysmal form AF (n = 80) and group with persistent form AF (n = 34). All patients underwent RFA. All patients underwent transthoracic echocardiography (before RFA, after 72 hours, after 3 months, after a year) against the background of sinus rhythm. During the study, the LA reservoir function, the LA conduit function, the LA emptying fraction, the peak right atrium longitudinal strain was evaluated. Results At the beginning of the study, patient performance in the groups with paroxysmal form AF and persistent form AF was statistically consistent: LA reservoir function 27.0 ± 4.6% and 21.1 ± 4.9% (р = 0.047); LA conduit function 17.2 ± 5.5% and 16.2 ± 4.7% (р = 0.58); LA emptying fraction 9.9 ± 4.1% and 7.6 ± 2.7% (р = 0.056); the peak right atrium longitudinal strain 28.2 ± 5.6% and 27.8 ± 6.9% (р = 0.82). In the group with paroxysmal form AF and CKD 3 after RFA, LA functions statistically significantly decreased after 3 days: LA reservoir function 20.7 ± 3.9% (р < 0.001), LA conduit function 11.9 ± 3.1% (р < 0.001), LA emptying fraction 7.83 ± 3.4 (р < 0.001) and increased the peak right atrium longitudinal strain 31.1±6.5% (р = 0.021). After 3 months, there was a statistically significant increase in LA reservoir function 26.6 ± 4.3% (р < 0.001), LA conduit function 16.7 ± 4.3% (р < 0.001), LA emptying fraction 9.9 ± 4.1% (р = 0.004). After a year, LA reservoir function was 26.2 ± 5.7% (P < 0.001), LA conduit function 16.8 ± 5.0% (P < 0.001), LA emptying fraction 9.5 ± 3.6% (P = 0.003), which was statistically significantly higher than in the early postoperative period. The peak right atrium longitudinal strain after a year was statistically significantly higher than before RFA 33.6 ± 6.3% (P < 0.001). In patients with persistent form AF and CKD 3 after RFA, LA functions were statistically significantly depressed: LA reservoir function 19.0 ± 4.3% (р < 0.001), LA conduit function 14.0 ± 3.9% (р < 0.001), LA emptying fraction 5.3 ± 2.6% (р = 0.001). After 3 months, the LA reservoir function increased statistically significantly 23.8 ± 4.1% (р < 0.001), LA conduit function 16.5 ± 3.2% (р < 0.001), LA emptying fraction 7.2 ± 2.2% (р = 0.003). After a year, LA reservoir function was 25.1 ± 3.7% (P < 0.001), LA conduit function 16.5 ± 3.2% (P = 0.001), LA emptying fraction 8.6 ± 2.7% (P = 0.008), which was statistically significantly higher than in the early postoperative period. The peak right atrium longitudinal strain after a year was 31.7 ± 6.2% (P = 0.03), which was statistically significantly higher than before RFA. Conclusion In the early postoperative period after RFA in patients with CKD stage III and AF, inhibition of the LA reservoir function, conduit function and emptying fraction is observed, while the peak right atrium longitudinal strain increases. Recovery of LA deformation is noted 3 months after RFA and also persists for a year. The peak right atrium longitudinal strain after a year is statistically significantly higher compared to the preoperative and 3-month stages.

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