Background:Accurate echocardiographic parameters to predict maintenance of sinus rhythm in patients with atrial fibrillation (AF) are poorly defined. This study was conducted to assess the atrial myocardial properties during AF through strain rate and strain, and to compare their prognostic value in maintaining sinus rhythm after pulmonary vein ablation in patients with lone AF. Methods:Thirty-three consecutive patients with lone AF underwent TTE, and strain and strain rate examinations before pulmonary vein ablation. Maintenance of sinus rhythm was assessed during the 8짹3.4 months follow-up. Strain and strain rate values in AF patients were compared with those of age- and sex-matched referents. Moreover, clinical and echocardiographic parameters of patients with maintenance of sinus rhythm (n=22) over the follow-up period were compared with those from patients with AF recurrence (n=11). Results: Strain and strain rate was significantly reduced (p=0.001) in patients (strain, 11.4%; strain rate, 0.9짹0.6 seconds-1) compared with referents (strain, 92짹26%; strain rate, 4.2짹1.8 seconds-1). Strain was significantly higher in the patients with sinus rhythm maintenance compared with AF recurrence (p=0.004, 13.8짹7.1% vs. 6.4짹4.8%). The patients with sinus rhythm maintenance also showed more paroxysmal AF compared with AF recurrence (p=0.009, 77.3% vs 22.7%). Atrial strain (p = 0.043, odds ratio=0.21, 95% CI 0.01 to 4.19) parameters alone were confirmed as a independent predictor of sinus rhythm maintenance by multivariable analysis. Conclusions:Patients with higher atrial strain appear to have a greater likelihood of staying in sinus rhythm after pulmonary vein ablation. If the current data are verified in future studies, then addition of antiarrhythmic agents and maintenance of anticoagulants for a longer period may need to be considered in those with lower atrial strain.