Effects of Pulmonary Vein Isolation on Left Atrial Hemodynamic and Mechanical Function: Insights from Advanced and Emerging Echocardiographic Parameters in Responders and Non-Responders

Background: Atrial fibrillation (AF) is associated with progressive remodeling of the left atrium (LA). Pulmonary vein isolation (PVI) is an established rhythm-control strategy; however, its long-term impact on LA mechanical and hemodynamic function remains insufficiently defined. Objectives: Our objective was to assess long-term changes in LA structure, mechanics, and hemodynamics after PVI, and to compare remodeling patterns between responders and non-responders. Methods: In this prospective observational study, 51 patients undergoing PVI were enrolled. Transthoracic echocardiography was performed before ablation and after 12 months. LA assessment included volumetric parameters, speckle-tracking-derived strain, and advanced functional indices (LA ejection fraction [LAEF], LA emptying fractions, LA function index [LAFI], and LA stiffness index [LAS-si]). Results: Forty-two patients (mean age 61 ± 9 years, 59.6% male) were included; a total of 32 (76.2%) were classified as responders and 10 (23.8%) as non-responders. Longitudinal differences between groups were tested using a Group × Time mixed-design ANOVA with Benjamini–Hochberg correction across the 19 echocardiographic parameters assessed. Non-responders showed a numerically greater decline in peak left atrial reservoir strain (PALS) than responders (95% CI 2.28–10.44; nominal p = 0.003), but this did not remain significant after correction for multiple comparisons (FDR-adjusted p = 0.06) and is therefore considered hypothesis-generating. Directionally consistent, non-significant trends toward greater adverse change among non-responders were also observed for LA volume index, LA ejection fraction, and LA stiffness index (all nominal p 0.07–0.13; all FDR-adjusted p ≥ 0.32). No parameter retained significance after correction for multiple comparisons. Conclusions: In this hypothesis-generating, exploratory study, recurrent arrhythmia after PVI was associated with numerically greater adverse left atrial remodeling than freedom from recurrence, but between-group differences did not remain statistically significant after correction for multiple comparisons. These findings should not be interpreted as evidence that PVI itself caused the observed changes, particularly in the absence of a non-ablated control group, and require confirmation in larger, adequately powered prospective studies incorporating continuous rhythm monitoring.