Key result
Baseline left atrial volume <114 cc linked to ~47% lower arrhythmia recurrence after PVI.
Why the study?
The authors sought to assess the role of left atrial volume in predicting atrial arrhythmia recurrence and atrial fibrillation burden in patients with persistent atrial fibrillation undergoing pulmonary vein isolation.
Does baseline left atrial volume predict atrial arrhythmia recurrence in patients with persistent atrial fibrillation undergoing first-time pulmonary vein isolation?
Cohort (n=361)
Yes
Does baseline left atrial volume predict atrial arrhythmia recurrence in patients with persistent atrial fibrillation undergoing first-time pulmonary vein isolation?
Hazard Ratio: 0.53 (95% CI 0.35–0.82)
Absolute Event Rate: 72.5% vs 52.8%
p-value: p=0.004
Baseline left atrial volume <114 cc identifies a subgroup of patients with persistent AF who have high success rates (72.5% at 1 year) with pulmonary vein isolation alone.
BACKGROUND: Left atrial volume (LAV) is a known predictor of atrial arrhythmia (AA) recurrence after pulmonary vein isolation (PVI). OBJECTIVES: The authors sought to assess the role of LAV in predicting AA recurrence and atrial fibrillation (AF) burden in patients with persistent AF (PerAF) undergoing PVI. METHODS: The DECAAF-II trial was a prospective randomized controlled trial of PerAF patients undergoing first-time ablation. Patients underwent late gadolinium-enhanced magnetic resonance imaging to calculate baseline LAV and baseline atrial fibrosis. Patients provided single-lead home electrocardiogram strips once daily and upon symptom onset. The primary endpoint was defined as freedom from recurrent AA following a 90-day blanking period through 365 days postprocedure. SMURDEN (Smartphone AF burden) was calculated by dividing the total number of days in AF by the total number of days when strips were sent. A covariate-adjusted Cox regression model was performed to identify independent predictors of success. Univariate and multivariate analysis was performed to predict SMURDEN beyond the 3-month blanking period. RESULTS: = 0.12, P < 0.001); only LAV and age remained significantly related. CONCLUSIONS: In patients with PerAF undergoing PVI as the first ablation procedure, LAV is a strong predictor of AA recurrence and SMURDEN. LAV larger than 114 cc was associated with more than a 40% risk of recurrent arrhythmia.
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Mekhael et al. (2026) conducted a cohort in Persistent Atrial Fibrillation (n=361). Left atrial volume <114 cc vs. Left atrial volume ≥114 cc was evaluated on Freedom from recurrent atrial arrhythmia following a 90-day blanking period through 365 days postprocedure (HR 0.53, 95% CI 0.35-0.82, p=0.004). In patients with persistent atrial fibrillation undergoing first-time pulmonary vein isolation, a baseline left atrial volume <114 cc was associated with a 47% lower risk of arrhythmia recurrence (HR 0.53) and a 72.5% 1-year freedom from recurrence compared to 52.8% in those with larger volumes.
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