What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation (n=165). Intervention: Catheter ablation. Primary outcome: Atrial tachyarrhythmia recurrence (HR 1.246, 95% CI 1.048-1.482, p=0.013).

What does this research mean for the field?

Elevated mitral E/e' and right ventricular systolic pressure at 3 months post-ablation independently predict atrial tachyarrhythmia recurrence, whereas left atrial strain does not. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

October 20, 2025Open Access

Hemodynamic Echocardiographic Parameters in the Early Post-Atrial Fibrillation Ablation Period as Predictors of Recurrence

Key Result

Elevated mitral E/e′ and right ventricular systolic pressure at 3 months post-ablation independently predicted atrial tachyarrhythmia recurrence (HR 1.246 and 1.111, respectively).

Study Design

Type

Cohort (n=165)

Multicenter

Structured PICO

Do early post-ablation hemodynamic echocardiographic parameters predict atrial tachyarrhythmia recurrence in patients undergoing de novo AF ablation?

Population

165 consecutive patients undergoing de novo atrial fibrillation (AF) ablation between 2019 and 2021

Intervention

Echocardiographic assessment at 3 months post-ablation (evaluating left ventricle diastolic function, E/e', right ventricular systolic pressure, and left atrium strain)

Comparator

Comparison between patients with and without atrial tachyarrhythmia recurrence

Outcome

Atrial tachyarrhythmia recurrence over a median follow-up of 359 days

Assessment of left ventricular diastolic function (E/e' and RVSP) at 3 months post-ablation serves as a more significant predictor of atrial fibrillation recurrence than left atrial strain.

Main Result

Effect estimate: HR 1.246 (95% CI 1.048-1.482)

p-value: p=0.013

Limitations

Continuous rhythm monitoring was not performed for all patients, potentially missing subclinical arrhythmias.
Echocardiographic parameters may have been influenced by the acute effects of AF.
Potential confounding by baseline valvular disease and pre-existing pulmonary hypertension.
Evaluation of atrial substrate, such as voltage mapping, was not systematically performed.
Direct measurement of LA pressure during ablation was not performed.
Observational design limits the ability to establish causality.

Abstract

BACKGROUND: Atrial fibrillation (AF) recurrence after ablation requires predictors for better management. This study evaluated early post-ablation changes in echocardiographic parameters, clarifying the relative importance of left ventricle (LV) diastolic function and left atrium (LA) strain for recurrence prediction. METHODS AND RESULTS: The study prospectively enrolled 165 consecutive patients undergoing de novo AF ablation between 2019 and 2021. Echocardiography was performed before and 3 months after ablation. Three months after ablation, LA volume and LA strain (reservoir and contraction phases) decreased significantly and the LV ejection fraction improved. Extrapulmonary vein LA ablation was associated with significantly lower LA strain at 3 months. Over a median follow-up of 359 days, atrial tachyarrhythmia recurred in 45 (27.3%) patients. Three months after ablation, there was no significant difference in LA strain between groups with and without recurrence, but mitral E/e' and right ventricular systolic pressure (RVSP) were significantly higher in the group with recurrence (mitral E/e' 7.4±2.2 vs. 10.4±4.1; RVSP 23.1±3.5 vs. 28.4±4.8 mmHg; P<0.001 for both). Multivariable analysis identified E/e' and RVSP at 3 months as independent predictors of recurrence (hazard ratios 1.246 and 1.111, respectively), but not LA strain. CONCLUSIONS: Following AF ablation, hemodynamic factors appear to be more significant predictors of recurrence than LA strain. Assessment of LV diastolic function during the early post-ablation period may help identify patients at high risk of recurrence.

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