Predictive value of left ventricular structural and functional parameters on atrial fibrillation recurrence after pulmonary vein isolation

Abstract Introduction Atrial fibrillation (AF) is a common arrhythmia, with pulmonary vein isolation (PVI) being a cornerstone treatment for symptomatic cases. However, AF recurrence post-ablation remains a challenge, necessitating better predictors for long-term success. Purpose To evaluate the predictive value of left ventricular (LV) structural and functional parameters for AF recurrence following PVI. Methods This retrospective, single-center study involved AF patients who underwent first-time PVI between 2015 and 2024, with prior formal echocardiographic evaluation. AF recurrence at 6 and 12 months was determined using 12-lead ECG and available Holter monitoring. Receiver operating characteristic analysis assessed the predictive value of LV echocardiographic parameters. Results Of the 216 patients who underwent PVI, 72 met the inclusion criteria. Follow-up was completed by 60 patients at 6 months and 51 patients at 12 months. The median interval between echocardiography and PVI was 312 days [IQR 120–610]. AF recurrence occurred in 9 patients (15.0%) at 6 months and 15 patients (29.4%) at 12 months. At 6 months, LV ejection fraction had the highest AUC of 0.67, sensitivity of 100.0%, and specificity of 43.5%, with a cutoff of ≤62 (p=0.03). Indexed LV mass showed an AUC of 0.58 (p=0.51). Global longitudinal strain had an AUC of 0.56 (p=0.74). Indexed LV end-diastolic volume had an AUC of 0.52 (p=0.86). At 12 months, global longitudinal strain had the highest AUC of 0.62, sensitivity of 77.8%, and specificity of 64.7%, with a cutoff of ≤-19 (p=0.32). Indexed LV end-diastolic volume had an AUC of 0.56 (p=0.64). LV ejection fraction had an AUC of 0.54 (p=0.63). Indexed LV mass had an AUC of 0.53 (p=0.73). Conclusion LV parameters showed no strong diagnostic performance in predicting AF recurrence post-PVI at 6 and 12 months. While LV ejection fraction had the highest AUC at 6 months, its specificity was limited. Nevertheless, this study has limitations, including a small sample size, low inclusion rate (selection bias), dropout rate (attrition bias), and variability in the time between echocardiography and PVI, which reduce the reliability of our findings. Larger studies with standardized protocols are needed to better assess the role of LV parameters in predicting AF recurrence.