LAAEV-centric atrial failure phenotype and a novel integrative score for predicting early recurrence after AF ablation

Background: Early recurrence of atrial tachyarrhythmia (ERAF) after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) remains a major clinical challenge. While left atrial diameter (LAD) is a known predictor, the role of atrial mechanical function, particularly left atrial appendage emptying velocity (LAAEV), and its integration with other markers needs clarification. Methods: This single-center retrospective cohort study included 157 drug-refractory non-valvular AF patients undergoing first-time RFCA. Among them, 53 (33.8%) developed ERAF within the 90-day blanking period. Baseline clinical, echocardiographic (including LAD and LAAEV), and biochemical (NT-proBNP) data were collected. The primary endpoint was ERAF (atrial tachycardia/flutter/fibrillation ≥30 s) within the 90-day blanking period. Predictive models were developed using logistic regression. An integrative AF Recurrence Index (AF-RI) was derived and validated internally. Results: -trend < 0.001). Conclusion: LAAEV is a potent, independent predictor of ERAF, central to an "atrial failure" phenotype. The integrative AF-RI score provides a simple, bedside-friendly tool for individualized risk stratification, enabling clinicians to identify high-risk patients (e.g., those with LAAEV < 35 cm/s) who may benefit from intensified monitoring or tailored therapeutic strategies post-ablation.