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04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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32. Cardiovascular Nursing
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Diagnostic performance of pre-procedural left atrial size and strain in predicting long-term atrial fibrillation recurrence after pulmonary vein isolation
Session:
Sessão de Posters 25 - Resultados e recorrência após ablação de FA
Speaker:
Bárbara Lage Garcia
Congress:
CPC 2026
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Bárbara Lage Garcia; Emídio Mata; Filipa Castro; Luísa Pinheiro; Margarida de Castro; Daniela Ferreira; Joana Gomes; Sílvia Ribeiro; Lucy Calvo; Olga Azevedo; António Lourenço
Abstract
<p>Background: Pulmonary vein isolation (PVI) is a key treatment for atrial fibrillation (AF), yet recurrences are common. Left atrial (LA) size and strain (LAS) reflect structural and functional remodeling and may help predict post-ablation outcomes. </p> <p>Aim: Evaluate the predictability of pre-procedural echocardiographic LA parameters in AF recurrence at 24 and 36 months after first-time PVI. </p> <p>Methods: This retrospective, single-center study included patients with AF who underwent first-time PVI between 2015-2024 and had available pre-procedural echocardiogram. AF recurrence was determined by 12-lead ECG or Holter monitoring during follow-up. Time-dependent ROC analyses using the nearest-neighbor method assessed the predictive value of LA parameters for recurrence at 2 and 3 years, with AUCs, bootstrapped 95% confidence intervals (CI), and optimal cut-offs determined. </p> <p>Results: The analysis included 72 patients. No differences were detected in comorbidities, except for higher prevalence of diabetes in AF recurrence (p=0.003). Median time from echocardiography to PVI was 312 days (IQR 120–610), and median follow-up was 335.5 days (IQR 158.5–765.2). Annualized AF recurrence, from Kaplan-Meier analysis, was 19.9% per patient-year. At 2-years, indexed LA diameter showed the greatest discriminatory ability for predicting AF recurrence (AUC=0.629 [0.482–0.811] cut-off=22.2mm/m²; 46.6% sensitivity; 73.4% specificity), followed by the indexed LA end-diastolic volume (AUC=0.551 [0.429–0.755] cut-off=35.3mL/m²; 45.3% sensitivity; 64.5% specificity). LAS parameters showed limited predictive value, with AUCs below 0.45 across reservoir, conduit, and contraction phases. At 3 years, similar patterns were observed. Indexed LA diameter (AUC=0.645 [0.521–0.818] cut-off=21.5mm/m²; 53.1% sensitivity; 69.8% specificity) and indexed LA volume (AUC=0.651 [0.496–0.802] cut-off=28.2mL/m²; 79.7% sensitivity; 44.0% specificity) continued to outperform LAS-derived indices. Overall, structural LA measures demonstrated modest but superior predictive ability compared with LAS. </p> <p>Discussion: The modest predictive performance observed may reflect several limitations, including the small sample size, variable intervals between imaging and PVI and selection bias. These factors restrict the generalizability of the findings and the strength of conclusions on the prognostic value of LA parameters. Larger prospective studies are warranted to clarify the role of LAS in predicting AF recurrence after PVI. </p>
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