Diagnostic performance of pre-procedural left atrial size and strain in predicting long-term atrial fibrillation recurrence after pulmonary vein isolation
A Castro Pinto, B Lage Garcia, E Mata, F Castro, L Pinheiro, M Castro, D Goncalves, J Gomes, S Ribeiro, L Calvo, O Azevedo, A LourencoAbstract
Background
Pulmonary vein isolation (PVI) is a key treatment for atrial fibrillation (AF), yetrecurrences are common. Left atrial (LA) size and strain (LAS) reflect structural and functionalremodeling and may help predict post-ablation outcomes.
Purpose
Evaluate the predictability of pre-procedural echocardiographic LA parameters in AFrecurrence at 24 and 36 months after first-time PVI.
Results
The analysis included 72 patients. No differences were detected in comorbidities,except for higher prevalence of diabetes in AF recurrence (p=0.003). Median time fromechocardiography to PVI was 312 days (IQR 120–610), and median follow-up was 335.5 days(IQR 158.5–765.2). Annualized AF recurrence, from Kaplan-Meier analysis, was 19.9% perpatient-year. At 2-years, indexed LA diameter showed the greatest discriminatory ability forpredicting AF recurrence (AUC=0.629 [0.482–0.811] cut-off=22.2mm/m²; 46.6% sensitivity;73.4% specificity), followed by the indexed LA end-diastolic volume (AUC=0.551 [0.429–0.755] cut-off=35.3mL/m²; 45.3% sensitivity; 64.5% specificity). LAS parameters showedlimited predictive value, with AUCs below 0.45 across reservoir, conduit, and contractionphases. At 3 years, similar patterns were observed. Indexed LA diameter (AUC=0.645 [0.521–0.818] cut-off=21.5mm/m²; 53.1% sensitivity; 69.8% specificity) and indexed LA volume(AUC=0.651 [0.496–0.802] cut-off=28.2mL/m²; 79.7% sensitivity; 44.0% specificity)continued to outperform LAS-derived indices. Overall, structural LA measures demonstratedmodest but superior predictive ability compared with LAS.
Conclusion
The modest predictive performance observed may reflect several limitations,including the small sample size, variable intervals between imaging and PVI and selection bias.These factors restrict the generalizability of the findings and the strength of conclusions on theprognostic value of LA parameters. Larger prospective studies are warranted to clarify the roleof LAS in predicting AF recurrence after PVI.For image description, please refer to the figure legend and surrounding text.