Work

Pre-procedural left atrial strain and clinical features for predicting recurrence after first catheter ablation of persistent atrial fibrillation: a prospective cohort study

Year: 2026

Type: article

Abstract: Background Recurrence after the first ablation for persistent atrial fibrillation (AF) is common. Existing clinical and structural prediction models have limited performance. Peak atrial longitudinal strain (PALS) quantifies left atrial function and may improve risk stratification. Objective To develop and validate a 12-month recurrence prediction model for persistent AF by integrating PALS with clinical features, and to evaluate its performance and clinical utility. Methods Single-center prospective cohort; of 629 patients screened, 429 were enrolled, and 410 were included in the final analysis after exclusions for image quality and loss during the blanking period. Pre-procedural PALS was measured with standardized quality control. The outcome was the first recurrence (>30 s) between the end of the 90-day blanking period and 12 months. Cox models with restricted cubic splines assessed the dose–response. Model performance (C-index, time-dependent AUC, Brier score, calibration) was compared among “Clinical-only”, “Clinical + PALS”, and “Clinical + LAVI” models. Reclassification (NRI/IDI) and clinical net benefit (decision curve analysis) were evaluated, along with sensitivity and interaction analyses. Results PALS independently predicted recurrence (per 1% decrease: HR 1.06, 95% CI 1.03–1.10; p < 0.001), with excellent reproducibility (ICC intraobserver 0.91–0.93, interobserver 0.87–0.91). Adding PALS to the Clinical-only model improved discrimination (C-index 0.74 vs. 0.66; ΔAUC 0.08, p < 0.001) and calibration ( α = −0.02, β = 0.94). Reclassification improved (NRI 0.43; IDI 0.07; p < 0.01). The Clinical + PALS model provided greater net benefit across thresholds of 10%–30% (max ΔNB 0.06 at 24%). The PALS effect was consistent across acquisition rhythms ( p -interaction = 0.417). Adding LAVI yielded more modest improvement (C-index 0.69; ΔAUC 0.03, p = 0.084). Conclusions Pre-procedural PALS significantly improves individualized prediction of 12-month recurrence after first ablation for persistent AF when combined with clinical features. The model shows robust performance and clinical net benefit, supporting PALS as a core functional metric in pre-procedural assessment.

Source: Frontiers in Cardiovascular Medicine

DOI: 10.3389/fcvm.2026.1764723

Authors: Qunfang Tu, Dongping Xiao

Institution: Third Affiliated Hospital of Nanchang University

Language: English

Topic: Atrial Fibrillation Management and Outcomes

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801