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<p>It is observed that some atrial fibrillation (AF) patients develop right heart enlargement and severe right heart failure, which affect the prognosis. An abnormal right atrioventricular coupling index (RACI) indicates that AF has led to significant right atrial and right ventricular dysfunction. However, right atrial (RA) remodeling in AF patients is rarely assessed and data on the prognosis of RA is limited. This study aims to determine if the RACI can be used to predict the risk of long-term adverse outcomes in a cohort of patients with non-valvular AF after catheter ablation (CA). A total of 123 non-valvular AF patients who underwent CA in our center were enrolled in this retrospective study. Conventional and speckle tracking echocardiography (STE) were performed for AF patients before CA. Patients were followed up with until April 2025. The adverse outcomes were the composite of atrial tachyarrhythmia recurrence (ATa), stroke or transient ischemic attack (TIA), AF-associated hospitalization, pacemaker insertion and cardiovascular death. Logistic regression analysis was used to determine the optimal cutoff value of correlates for predicting adverse events. The median follow-up time was 5.3(1.6–5.5) years. Among the 123 AF patients, 69 experienced adverse outcomes. Multivariable logistic regression analysis showed that RACI and left atrial ejection fraction (LAEF) were the independent predictors of adverse events (95% CI, 0.643–0.806; <i>P &lt;</i> 0.0001 and 95% CI, 0.628–0.795; <i>P &lt;</i> 0.0001; respectively). The optimal cutoff values of RACI and LAEF were 70.97% and 35%, respectively. Spearman’s correlation analysis showed that RACI was negatively correlated with RA reservoir strain and RA boost strain (<i>r</i>=-0.583, <i>P</i> &lt; 0.001; <i>r</i>=-0.572, <i>P</i> &lt; 0.001, respectively), and LAEF was positively correlated with LA reservoir strain and LA boost strain (<i>r</i> = 0.859, <i>P</i> &lt; 0.001; <i>r</i> = 0.765, <i>P</i> &lt; 0.001, respectively). Increased RACI and impaired LAEF are strongly associated with long-term outcomes, with RACI showing better independent predictive value.</p>

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Right atrioventricular coupling index predicts adverse outcomes in patients with non-valvular atrial fibrillation undergoing catheter ablation: an echocardiography insight

  • 期刊论文

  • 发表日期：

    2026年1月19日

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  • Yuanzhi Li,
  • Qizhe Cai,
  • Weiwei Zhu,
  • Dichen Guo,
  • Xueyan Ding,
  • Yidan Li,
  • Xiuzhang Lv

摘要

It is observed that some atrial fibrillation (AF) patients develop right heart enlargement and severe right heart failure, which affect the prognosis. An abnormal right atrioventricular coupling index (RACI) indicates that AF has led to significant right atrial and right ventricular dysfunction. However, right atrial (RA) remodeling in AF patients is rarely assessed and data on the prognosis of RA is limited. This study aims to determine if the RACI can be used to predict the risk of long-term adverse outcomes in a cohort of patients with non-valvular AF after catheter ablation (CA). A total of 123 non-valvular AF patients who underwent CA in our center were enrolled in this retrospective study. Conventional and speckle tracking echocardiography (STE) were performed for AF patients before CA. Patients were followed up with until April 2025. The adverse outcomes were the composite of atrial tachyarrhythmia recurrence (ATa), stroke or transient ischemic attack (TIA), AF-associated hospitalization, pacemaker insertion and cardiovascular death. Logistic regression analysis was used to determine the optimal cutoff value of correlates for predicting adverse events. The median follow-up time was 5.3(1.6–5.5) years. Among the 123 AF patients, 69 experienced adverse outcomes. Multivariable logistic regression analysis showed that RACI and left atrial ejection fraction (LAEF) were the independent predictors of adverse events (95% CI, 0.643–0.806; P < 0.0001 and 95% CI, 0.628–0.795; P < 0.0001; respectively). The optimal cutoff values of RACI and LAEF were 70.97% and 35%, respectively. Spearman’s correlation analysis showed that RACI was negatively correlated with RA reservoir strain and RA boost strain (r=-0.583, P < 0.001; r=-0.572, P < 0.001, respectively), and LAEF was positively correlated with LA reservoir strain and LA boost strain (r = 0.859, P < 0.001; r = 0.765, P < 0.001, respectively). Increased RACI and impaired LAEF are strongly associated with long-term outcomes, with RACI showing better independent predictive value.