Association between left atrial stiffness index and atrial fibrillation recurrence following radiofrequency ablation

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Nonvalvular atrial fibrillation undergoing initial radiofrequency catheter ablation (n=240). Intervention: Z-score standardized left atrial stiffness index–body mass index product (z-LASI-BMI, per 1-SD increase) vs. Lower z-LASI-BMI (continuous per 1-SD or ≤-0.06 median / B1 tertile reference). Primary outcome: Atrial fibrillation recurrence within 12 months after ablation (any atrial tachyarrhythmia lasting ≥30 s after a 3-month blanking period) (HR 1.53, 95% CI 1.12-2.09, p=0.0008).

Q: What does this research mean for the field?

Left atrial stiffness index (LASI) and its standardized product with body mass index (z-LASI-BMI) are independent predictors of atrial fibrillation recurrence following radiofrequency catheter ablation. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Rong Chen; Huanhuan Huo; Ziying Wang; Luona Liu; Lanxin Shen; Miao Zhang; Ting Zhang; Donggang Han; Yajuan Wei

doi:10.1186/s12880-026-03046-z

November 10, 2026BMC Medical ImagingOpen Access

Association between left atrial stiffness index and atrial fibrillation recurrence following radiofrequency ablation

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Key result

Higher z-LASI-BMI linked to ~53% higher post-ablation AF recurrence risk per SD.

HR 1.53
95% CI 1.12-2.09
P=0.0008
n=240

Why the study?

Evidence linking the left atrial stiffness index (LASI) to AF recurrence was limited, and no prior study had investigated the association between the Z-score-standardized product of LASI and body mass index (z-LASI-BMI) and AF recurrence after radiofrequency catheter ablation (RFCA).

Does the Z-score-standardized product of left atrial stiffness index and body mass index (z-LASI-BMI) predict atrial fibrillation recurrence within 12 months in patients with nonvalvular atrial fibrillation undergoing initial radiofrequency catheter ablation?

Key Points

To assess the relationship between the left atrial stiffness index (LASI) and its Z-score-standardized product with body mass index (z-LASI-BMI) and atrial fibrillation recurrence following radiofrequency catheter ablation.
Retrospective study of 240 consecutive patients undergoing initial radiofrequency catheter ablation for atrial fibrillation between September 2022 and October 2024 at the Second Affiliated Hospital of Xi’an Jiaotong University.
Assessed echocardiographic left atrial stiffness parameters (LASI and z-LASI-BMI) alongside demographic and clinical variables over a 12-month post-ablation observation period.
Over the 12-month post-ablation follow-up, 60 patients (25.0%) developed recurrent atrial fibrillation.
In the fully adjusted multivariable Cox model, each 0.1-unit increase in LASI independently predicted recurrence (HR 1.11, 95% CI 1.03–1.20, P=0.006), with the highest tertile showing increased risk compared to the lowest tertile (HR 2.82, 95% CI 1.09–7.31, P=0.033).
The highest tertile of z-LASI-BMI independently conferred an elevated recurrence risk in fully adjusted analysis (HR 3.55, 95% CI 1.26–10.02, P=0.017) and improved predictive discrimination beyond LASI alone.

Study Design

Type

Cohort (n=240)

Blinding

Blinded image analysis

Multicenter

No

Structured PICO

Does the Z-score-standardized product of left atrial stiffness index and body mass index (z-LASI-BMI) predict atrial fibrillation recurrence within 12 months in patients with nonvalvular atrial fibrillation undergoing initial radiofrequency catheter ablation?

P

Population

240 adults (median age 64 years, 38.3% female) with nonvalvular atrial fibrillation undergoing first-time radiofrequency catheter ablation, excluding permanent AF or prior cardiac surgery, followed for 12 months.

E

Exposure

Evaluation of left atrial stiffness index (LASI, calculated as E/e′ ratio to left atrial reservoir strain [LASr]) and Z-score-standardized product of LASI and body mass index (z-LASI-BMI) via pre-ablation echocardiography (within 24 hours before initial radiofrequency catheter ablation).

O

Outcome

Atrial fibrillation recurrence within 12 months after radiofrequency catheter ablation, defined as any atrial tachyarrhythmia lasting ≥30 seconds occurring after a 3-month blanking period and documented by 12-lead ECG or 24-hour Holter monitoring.surrogate

Main Result

Hazard Ratio: 1.53 (95% CI 1.12–2.09)

p-value: p=0.0008

Both left atrial stiffness index (LASI) and its Z-score-standardized product with BMI (z-LASI-BMI) independently predict 12-month AF recurrence following initial radiofrequency ablation, with z-LASI-BMI offering superior discrimination over LASI alone.

Limitations

Retrospective, single-center design with a modest sample size and no internal or external validation.
Influence of imaging rhythm status on left atrial strain and stiffness index was not formally assessed.
Follow-up relied on scheduled ECG and 24-hour Holter monitoring rather than continuous monitoring, potentially missing asymptomatic recurrences.
Clinically relevant predictors such as LA volume index, obstructive sleep apnea, medication use, scar burden, and validated risk scores (e.g., APPLE) were not systematically collected.
Peri-procedural and procedural details (e.g., anticoagulation strategy, anesthesia type, mapping system, ablation indices, operator experience) were unavailable.
Single-center, retrospective cohort design
Requires external validation
Coronary imaging was performed only when clinically indicated, not systematically in all patients, which may be subject to ascertainment bias

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

z-LASI-BMI may refine post-ablation risk estimates; extends observational data on atrial stiffness but leaves prospective validation open.

Abstract

Background Growing evidence indicates that the left atrial stiffness index (LASI) serves as a straightforward and reliable surrogate for left atrial (LA) function. Although LASI has been linked to atrial fibrillation (AF) recurrence, supporting evidence remains limited. Obesity is also implicated in the pathophysiology of AF. Currently, no existing research has investigated the correlation between the Z-score-standardized product of LASI and body mass index (z-LASI-BMI) and AF recurrence. To the best of our knowledge, this is the first study to investigate the association between z-LASI-BMI and AF recurrence after radiofrequency catheter ablation (RFCA). We further evaluated the predictive value of LASI and z-LASI-BMI for post-ablation AF recurrence. Methods In this retrospective study conducted at the Second Affiliated Hospital of Xi’an Jiaotong University, 240 patients who underwent initial RFCA for AF were consecutively enrolled between September 2022 and October 2024. The analysis evaluated the association between left atrial stiffness parameters (LASI and z-LASI-BMI) and post-ablation AF recurrence. Results Over a 12-month observation period post-RFCA, 25.0% of participants exhibited AF recurrence. Multivariable regression analysis confirmed that both LASI and z-LASI-BMI independently predicted AF recurrence. Restricted cubic spline models revealed a positive linear relationship between LASI and z-LASI-BMI and AF recurrence rates. Additionally, adding the z-LASI-BMI index into the fully adjusted baseline risk model significantly improved the prediction of AF recurrence, as reflected by increases in the C-statistic, continuous net reclassification improvement, and integrated discrimination improvement, but requires external validation. Conclusions Both LASI and z-LASI-BMI were independently associated with AF recurrence after ablation. z-LASI-BMI improved discrimination beyond LASI alone but remains exploratory and requires external validation.

Discussion

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Cite This Study

Chen et al. (2026) conducted a cohort in Nonvalvular atrial fibrillation undergoing initial radiofrequency catheter ablation (n=240). Z-score standardized left atrial stiffness index–body mass index product (z-LASI-BMI, per 1-SD increase) vs. Lower z-LASI-BMI (continuous per 1-SD or ≤-0.06 median / B1 tertile reference) was evaluated on Atrial fibrillation recurrence within 12 months after ablation (any atrial tachyarrhythmia lasting ≥30 s after a 3-month blanking period) (HR 1.53, 95% CI 1.12-2.09, p=0.0008). Higher z-LASI-BMI independently predicted 12-month atrial fibrillation recurrence after radiofrequency ablation (adjusted HR 1.53 per 1-SD increase, 95% CI 1.12-2.09; P=0.0008).

synapsesocial.com/papers/6af354495b67d29976ea07af https://doi.org/10.1186/s12880-026-03046-z

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Association between left atrial stiffness index and atrial fibrillation recurrence following radiofrequency ablation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Association between left atrial stiffness index and atrial fibrillation recurrence following radiofrequency ablation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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