[Predictive value of the anatomical structure of pulmonary vein antrum for the recurrence of paroxysmal atrial fibrillation after radiofrequency catheter ablation].

Authors

Y K Liu, J J Li, J W Chen, X Y Yao, Z Wang, Y W Chen, J Z Dong

Published in

Zhonghua xin xue guan bing za zhi. Volume 54. Issue 7. Pages 791-797. Jul 24, 2026.

Abstract

Objective: To investigate the predictive value of pulmonary vein antrum anatomy for recurrence after radiofrequency catheter ablation (RFCA) in patients with paroxysmal atrial fibrillation (PAF). Methods: This was a retrospective cohort study. Patients with PAF who underwent successful first-time RFCA at the First Affiliated Hospital of Zhengzhou University from June 2019 to March 2021 were enrolled. All patients underwent cardiac CT angiography before ablation to measure left atrial diameter, as well as the circumference and area of bilateral pulmonary vein antrum orifices. The circularity parameters of bilateral pulmonary vein antrum orifices were calculated and denoted as pulmonary vein antrum-e (PVA-e), with left and right values recorded as LPVA-e and RPVA-e, respectively. All patients were followed up at 3, 6, 9, and 12 months after ablation by outpatient visit or telephone follow-up, and a standard electrocardiogram or Holter monitoring was performed at each follow-up. Recurrence of atrial fibrillation within 1 year after ablation was defined as the endpoint. Patients were divided into recurrence and non-recurrence groups according to whether recurrence occurred. Baseline characteristics were compared between the two groups, and Cox regression analysis was performed to identify independent predictors of recurrence after ablation. Receiver operating characteristic curves were used to evaluate the predictive performance of left atrial diameter, LPVA-e, and RPVA-e for post-ablation recurrence and to determine their optimal cutoff values. Kaplan-Meier curves were generated according to the optimal cutoff values of LPVA-e and RPVA-e, and differences in atrial fibrillation-free rate between groups were compared using the log-rank test. Results: A total of 188 patients with PAF (age (59.0±11.1) years, 76 (40.43%) females) were included. During the 1-year follow-up, 40 patients (21.28%) experienced recurrence after ablation. The left atrial diameter, LPVA-e, and RPVA-e were greater in the recurrent group compared to the non-recurrent group (P0.05). Multivariate Cox regression analysis showed that the left atrial diameter (HR=1.65, 95%CI: 1.07-2.56, P=0.025), LPVA-e (HR=1.13, 95%CI: 1.05-1.21, P0.001), and RPVA-e (HR=1.11, 95%CI: 1.01-1.22, P=0.031) were independent predictors of recurrence after RFCA. Receiver operating characteristic curve analysis showed that the area under the curve for LPVA-e was 0.737 (95%CI: 0.663-0.811), and the optimal cutoff value was 0.902, with a sensitivity of 82.5% and a specificity of 60.8%. The area under the curve for RPVA-e was 0.701 (95%CI: 0.610-0.791), and the optimal cutoff value was 0.927, with a sensitivity of 80.0% and a specificity of 55.4%. According to the optimal cutoff value, the bilateral PVA-e was divided into high and low groups. Kaplan-Meier curve analysis showed that atrial fibrillation-free rate was significantly lower in the high LPVA-e group than in the low LPVA-e group (log-rank P0.001), and similarly lower in the high RPVA-e group than in the low RPVA-e group (log-rank P0.001). Conclusion: Left atrial diameter, LPVA-e and RPVA-e are independent predictors of recurrence after RFCA in patients with PAF.

PMID:
42452921
Bibliographic data and abstract were imported from PubMed on 15 Jul 2026.

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