Predictive value of the minimum distance between the left atrial appendage and left superior pulmonary vein on cardiac CT for atrial fibrillation recurrence after radiofrequency ablation

WU Dandan; WANG Jun; YUAN Yuan; ZHU Xiaomei; ZHU Yinsu; CHEN Hongwu; XU Yi

doi:10.19300/j.2025.L21761

Abstract：Objective To investigate the predictive value of the minimum distance between left atrial appendage(LAA)and left superior pulmonary vein(LSPV),measured on cardiac computed tomography(CT),for atrial fibrillation(AF)recurrence within 2 years after the first radiofrequency ablation procedure.Methods A retrospective analysis was conducted on the clinical and imaging data of 342 AF patients who underwent cardiac CT,with a median age of 64(56,71)years.Based on recurrence status within 2 years,patients were divided into a recurrence group(n=106)and a non-recurrence group(n=236).Differences in clinical and cardiac CT parameters between the two groups were analyzed using the chi-square test or Mann-Whitney U test.Cox regression analysis was used to identify independent predictors of AF recurrence and construct predictive models.The area under the receiver operating characteristic(ROC)curve(AUC)was used to evaluate model performance,and DeLong's test was used to compare AUC values.Kaplan-Meier analysis was used to assess event-free survival,and the log-rank test was used to compare survival between groups.Results The proportion of patients with an end-diastolic LAA-LSPV distance(LAA-LSPVend-diastolic)<2 mm was significantly higher in the recurrence group than in the non-recurrence group(P<0.05).The recurrence group also had significantly higher end-diastolic and end-systolic volume indices of the left atrium and LAA(LAVImax,LAVImin,LAAVImax,LAAVImin)compared to the non-recurrence group(all P<0.05).Multivariate Cox regression identified(LAA-LSPVend-diastolic)<2 mm,LAAVImax,persistent AF,and NT-proBNP as independent predictors of recurrence.Three predictive models were developed:Model 1:clinical parameters only(persistent AF+NT-proBNP);Model 2:Model 1+LAAVImax;Model 3:Model 2+LAA-LSPVend-diastolic<2 mm.Model 3 had significantly better predictive performance than both Model 1(Z=2.829,P<0.05)and Model 2(Z=2.246,P<0.05).Conclusion LAA-LSPVend-diastolic<2 mm is an independent predictor of AF recurrence within 2 years after ablation and provides incremental prognostic value.