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

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Persistent Atrial Fibrillation (n=494). Intervention: Elevated pre- and post-ablation pulmonary artery systolic pressure (PASP) vs. Low pre- and post-ablation PASP. Primary outcome: Atrial fibrillation recurrence at 1 year in patients with LAVI ≤62 mL/m2 (p=0.001).

Q: What does this research mean for the field?

Dynamic peri-procedural changes in pulmonary artery systolic pressure (PASP), when combined with left atrial volume index (LAVI), provide incremental prognostic value for predicting atrial fibrillation recurrence after catheter ablation in patients with persistent AF. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Yoon Jung Park; Jiwon Park; Min-Su Jung; Tae-Wan Chung; Hee Jeong Lee; Jongmin Hwang; Hyungseop Kim; Hyoung‐Seob Park; In‐Cheol Kim

doi:10.4070/kcj.2026.0065

August 21, 2026Sunhwan'giOpen Access

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

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Key result

Persistently elevated PASP linked to ~168% higher AF recurrence post-ablation in patients with small LAVI.

P=0.001
n=494

Why the study?

AF recurrence after catheter ablation remains prevalent, particularly in patients with persistent AF, where left atrial enlargement is an established predictor.

Do dynamic peri-procedural changes in pulmonary artery systolic pressure (PASP) combined with left atrial volume index (LAVI) predict atrial fibrillation recurrence after catheter ablation in patients with persistent AF?

Key Points

To determine whether left atrial volume index and dynamic peri-procedural changes in pulmonary artery systolic pressure provide incremental prognostic value for arrhythmia recurrence following catheter ablation in patients with persistent atrial fibrillation.
Retrospective cohort analysis of 494 patients with persistent atrial fibrillation undergoing catheter ablation.
Comprehensive pre- and post-procedural echocardiography was performed to assess left atrial volume index (LAVI) and pulmonary artery systolic pressure (PASP), categorized by cut-offs of 62 mL/m2 and 24 mmHg, respectively.
Follow-up evaluated atrial fibrillation recurrence over 12 months using Kaplan-Meier and multivariable Cox proportional hazards regression analyses.
Multivariable Cox regression identified longer AF duration (HR, 1.06; 95% CI, 1.03–1.10; p<0.001) and larger LAVI per 10-unit increase (HR, 1.11; 95% CI, 1.02–1.20; p=0.016) as independent predictors of AF recurrence.
Kaplan-Meier analysis showed that patients with LAVI ≤62 mL/m2 and pre-ablation PASP ≤24 mmHg experienced the lowest AF recurrence rates (p=0.002).
Among patients with LAVI ≤62 mL/m2, those with persistently low pre- and post-ablation PASP (≤24 mmHg) had the lowest recurrence rate, whereas those with persistently high PASP (>24 mmHg) had the highest recurrence rate (p=0.001).

Study Design

Type

Cohort (n=494)

Multicenter

No

Structured PICO

Do dynamic peri-procedural changes in pulmonary artery systolic pressure (PASP) combined with left atrial volume index (LAVI) predict atrial fibrillation recurrence after catheter ablation in patients with persistent AF?

P

Population

494 patients with persistent atrial fibrillation who underwent catheter ablation and had pre- and post-procedural echocardiography, followed for one year to assess arrhythmia recurrence.

E

Exposure

Catheter ablation (circumferential pulmonary vein isolation using open-irrigated tip catheters, with additional ablation such as cavotricuspid isthmus, empirical linear, or complex fractionated electrogram ablation at the operator's discretion)

O

Outcome

Atrial fibrillation recurrence, defined as documented AF occurring beyond the 3-month blanking period within one-year post-ablationhard clinical

Main Result

Absolute Event Rate: 51% vs 19%

p-value: p=0.001

Integrating left atrial volume index with dynamic peri-procedural changes in pulmonary artery systolic pressure provides incremental prognostic value for predicting AF recurrence after catheter ablation in patients with persistent AF.

Limitations

Modest sample size may have limited statistical power to detect independent associations.
Single-center observational study design limits the generalizability of the results.
PASP was estimated non-invasively using echocardiography, which is subject to measurement variability and potential inaccuracy.
Differences in cardiac rhythm between baseline (AF) and post-ablation (sinus rhythm) assessments may have influenced PASP measurements.
Post-ablation echocardiography was performed within 1 week, meaning observed PASP changes likely reflect acute hemodynamic alterations rather than structural remodeling.
Retrospective nature of the study
Timing of post-ablation echocardiography within 1 week may capture acute effects like fluid loading, transient atrial stunning, and ablation-induced inflammation and edema rather than true remodeling

Implication

May refine post-ablation AF recurrence risk stratification with LAVI; hypothesis-generating and requires prospective validation before practice change.

Abstract

Atrial fibrillation (AF) recurrence after catheter ablation remains prevalent, especially in patients with persistent AF.Left atrial enlargement is a well-established marker of atrial remodeling and a strong predictor of AF recurrence after catheter ablation.This study demonstrates that dynamic peri-procedural changes in pulmonary artery systolic pressure (PASP), when interpreted alongside left atrial volume index (LAVI), provide incremental prognostic information for AF recurrence after ablation.Comprehensive pre-and postprocedural echocardiographic evaluation of LAVI and PASP can significantly enhance individualized risk stratification and patient selection for persistent AF ablation.

Discussion

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Cite This Study

Park et al. (2026) conducted a cohort in Persistent Atrial Fibrillation (n=494). Elevated pre- and post-ablation pulmonary artery systolic pressure (PASP) vs. Low pre- and post-ablation PASP was evaluated on Atrial fibrillation recurrence at 1 year in patients with LAVI ≤62 mL/m2 (p=0.001). In patients with persistent atrial fibrillation and a relatively small left atrial volume index (≤62 mL/m2), persistently elevated pulmonary artery systolic pressure before and after ablation was associated with a 51% recurrence rate at one year, compared to 19% in those with persistently low pressure.

synapsesocial.com/papers/6a8aae507677a341144473df https://doi.org/10.4070/kcj.2026.0065

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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

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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