ABC | Volume 110, Nº4, April 2018

Original Article Muñoz et al Atrial fibrillation ablation in valve disease Arq Bras Cardiol. 2018; 110(4):312-320 Figure 3 – Strain and strain rate curves in a healthy individual (A and B, respectively) and in a post-surgery patient (C and D, respectively). Table 3 – Univariate analysis AF recurrence n = 13 SR maintenance n = 31 p (Univariate) LA biplane volume (ml/m 2 ) 76.4 ± 25.5 63.7 ± 19.2 0.059 Age (years) 71.5 ± 7 66 ± 9 0.055 Mitral surgery 9 (25%) 27 (75%) 0.087 Antiarrhythmic treatment at discharge 3 (23%) 10 (77%) 0.498 ACE inhibitors at discharge 6 (28.6%) 15 (71.4%) 0.454 AF duration > 1 year before surgery 9 (34.6%) 17 (65.4%) 0.748 LASs* 14.1 (13.1-20.1) 17.2 (15.4-21.4) 0.961 LASa* 5.6 (3.3-6.3) 5.9 (4.7-7.4) 0.385 LASRe* -0.5 (-0.45- -0.67) -0.5 (-0.45- -0.67) 0.965 LASRa* -0.4 (-0.25- -0.59) -0.4 (-0.25- -0.58) 0.961 P values were calculated with the use of the Mann–Whitney or Fisher´s exact tests. (*) Variables with non-normal distribution (median and intercuartile range [P 25 -P 75 ]). ACE: angiotensin converting enzyme; AF: atrial fibrillation; LA: left atrium; LASs: LA systolic strain; LASa: LA diastolic strain; LASRe: early LA strain rate; LASRa: late LA strain rate. setting. We found that after 28 months, 50% of VHD patients with initial successful ablation remained in SR. Veasey et al. 14 reported rates of SR of 74% in paroxysmal AF and 51% in persistent AF; nevertheless, the mean follow‑up time was only 6 months, and, 39% of these patients had exclusively coronary artery bypass surgery. Similar results were found by Gaynor et al. 15 and Budera et al.; 16 71% of patients had sustained SR after 6 months and 53.2% after one year respectively, but, these series included patients with lone AF surgery and revascularization for ischemic heart disease. Beukema et al. 17 reported one of the largest series including 285 patients with structural heart disease, finding that SR was present in 57.1% of patients after 5 years of follow- up; however, this study does not state the rate of patients with VHD. The consensus statement of the American Society of Echocardiography and the European Association of Echocardiography suggests that LA mechanics can be assessed after AF to predict the maintenance of sinus rhythm and after percutaneous atrial septal defect repair. In addition, LA mechanics may offer suitable parameters to identify patients 316