Impact of symptomatic status on 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, L Calvo, S Ribeiro, O Azevedo, A LourencoAbstract
Background
Atrial fibrillation (AF) is a common arrhythmia often requiring pulmonary vein isolation (PVI) for symptom management. Symptomatic AF, characterized by AF-related palpitations, dizziness, syncope, or thoracalgia, may reflect atrial structural or functional abnormalities linked to disease severity.
Purpose
To evaluate baseline comorbidities, echocardiographic differences, and post-PVI recurrence rates between symptomatic and non-symptomatic AF.
Methods
This retrospective, single-center study included AF patients who underwent first-time PVI (2015-2024) with prior echocardiographic assessment available. Symptomatic AF was defined by documented AF-related palpitations, dizziness, syncope, or thoracalgia before PVI. AF recurrence was identified via 12-lead ECGs or Holter monitoring. Cox regression was used to evaluate recurrence risk.
Results
Seventy-two patients who underwent PVI met the inclusion criteria, with 51 classified as symptomatic. The median time from echocardiography to PVI was 312 days [IQR 120–610] with a mean follow-up of 652.6±576.6 days. Among symptomatic patients, palpitations were the most common symptom (78.4%). Symptomatic and non-symptomatic patients had similar median ages (61.6 vs 62.1 years p=0.84) and sex distribution (male: 60.8% vs 61.9% p=0.93). There was no significant difference in comorbidities between groups. Time from AF diagnosis to ablation was longer in non- symptomatic patients (1185 vs. 965 days p=0.95), but the difference was not statistically significant. Echocardiographic analysis revealed no significant differences in left atrial (LA) dimensions or left ventricular measures. LA strain parameters (reservoir, conduit, and contractile strain) were also comparable between groups. Annualized AF recurrence, from Kaplan-Meier analysis, was 19.9% per patient-year. There was no significant difference in AF recurrence after PVI between symptomatic and asymptomatic patients (HR 1.39 [0.55–3.52] p=0.49), suggesting that symptom status at baseline did not predict long-term ablation outcomes.
Conclusion
Symptomatic AF did not predict outcomes after PVI nor structural remodeling, as echocardiographic markers were similar between groups. Symptomatic patients also showed no higher recurrence risk. However, the small sample size, timing between echocardiography and PVI, and reliance on clinical records may have limited accuracy and generalizability. Further prospective studies are needed to clarify whether symptoms predict remodeling and/or post-ablation outcomes.For image description, please refer to the figure legend and surrounding text.