Predictors of atrial fibrillation recurrence after radiofrequency catheter ablation: a single-center experience

Background Atrial fibrillation (AF) recurrence remains a major limitation of catheter ablation. Identifying predictors of recurrence may improve patient selection and long-term rhythm outcomes. Purpose To evaluate clinical, echocardiographic, and procedural predictors of AF recurrence after radiofrequency ablation in a single center. Methods We retrospectively analyzed 480 patients undergoing pulmonary vein isolation with contact-force guided RF ablation. Follow-up included ECG and Holter monitoring at predefined intervals. AF recurrence was defined as atrial tachyarrhythmia >30 seconds after a 3-month blanking period. Clinical features, comorbidities, echocardiographic parameters, and procedural data were compared between recurrence and non-recurrence groups. Logistic regression identified independent predictors. Results During a mean follow-up of 22.8 ± 9.2 months, 70 patients (14.5%) developed AF recurrence. Recurrence was associated with larger left atrial (LA) volume, longer AF symptom duration, prior cardioversion, and longer procedure time. In multivariate analysis, AF symptom duration (OR 1.013; p = 0.015) and history of cardioversion (OR 3.728; p < 0.001) remained independent predictors. LA volume and procedure time showed modest predictive value in ROC analysis. Conclusion Longer symptom duration and prior cardioversion independently predict AF recurrence after ablation. LA enlargement and prolonged procedure time reflect more advanced atrial remodeling. Early intervention and individualized preprocedural assessment may improve long-term outcomes.