Left Atrial Function and Strain Assessed by Three-Dimensional Echocardiography as Factors Associated With Atrial Fibrillation Recurrence After Pulmonary Vein Ablation

Abstract

Introduction: Recurrence of atrial fibrillation (AF) after pulmonary vein isolation (PVI) remains a major clinical challenge. Left atrial (LA) remodeling contributes to recurrence, but its predictive value is still under investigation. This study aimed to assess LA morphology, function, and strain using three-dimensional (3D) echocardiography and determine their association with AF recurrence. Methods and Results: This prospective, single-center study included 119 patients with paroxysmal or persistent AF who underwent radiofrequency or cryoballoon ablation. Six months after the procedure, an echocardiographic assessment was performed, evaluating LA volumes, reservoir, conduit, booster pump function, global longitudinal strain (GLS), and LA ejection fraction (LAEF). AF recurrence occurred in 26.1% of patients. Patients with recurrence had larger LA dimensions (p < 0.01) and reduced GLS, LAEF, and peak atrial longitudinal strain (PALS) (p < 0.001). Multivariate analysis identified GLS > −13.5% (OR = 3.495, p < 0.001) and LAEF < 27.5% (OR = 0.857, p < 0.001) as independent predictors of recurrence. ROC analysis confirmed their strong discriminatory ability (AUC: 0.941 and 0.812, respectively). Conclusion: LA remodeling and dysfunction are key predictors of AF recurrence after PVI. Reduced GLS and LAEF and increased LA size were independently associated with recurrence, supporting their role in risk stratification and personalized management. Incorporating 3D echocardiographic and strain-based analysis may enhance postablation surveillance and therapeutic decision-making.