The Stratified Association of Left Atrial Volume Index and Dynamic Change of Pulmonary Arterial Pressure on Prognosis After Catheter Ablation in Patients With Persistent Atrial Fibrillation.

BACKGROUND AND OBJECTIVES: Catheter ablation is a key strategy for rhythm control in atrial fibrillation (AF), yet recurrence remains frequent, particularly in persistent AF. This study evaluated echocardiographic parameters to predict post-ablation recurrence. METHODS: Patients with persistent AF who underwent catheter ablation and had both pre- and post-echocardiography between 2011 and March 2022 were enrolled. Post-ablation echocardiography was conducted within one week. Patients were stratified by median left atrial volume index (LAVI, 62 mL/m²) and pulmonary artery systolic pressure (PASP, 24 mmHg) on transthoracic echocardiography. The association between pre- and post-ablation PASP, stratified by LAVI size, and AF recurrence was then evaluated. RESULTS: A total of 494 patients were included. Those with LAVI ≤62 mL/m² and PASP ≤24 mmHg were younger, predominantly male, and had lower pulmonary vascular resistance and CHA2DS2-VASc scores. Kaplan-Meier analysis demonstrated the lowest AF recurrence rates in this group (p<0.01). Among patients with LAVI ≤62 mL/m², those with elevated pre- and post-ablation PASP had the highest recurrence rate (51%), while those with low pre- and post-ablation PASP had the lowest recurrence rate (19%) at one year. In patients with LAVI >62 mL/m², recurrence rates were generally higher (average 42%), and were less influenced by PASP variation. However, there was a trend toward a lower recurrence rate (32%) in patients with elevated pre-ablation PASP and low post-ablation PASP. CONCLUSIONS: Integrating LAVI with changes in PASP showed differences in post-ablation recurrence rate in patients with persistent AF. Pre- and post-ablation echocardiographic assessment of PASP can provide important insights for post-procedural management.