Left atrioventricular coupling index assessed by cardiac CT as a predictive marker for atrial fibrillation recurrence after ablation

Background The left atrioventricular coupling index (LACI) is a significant predictor of cardiovascular events, heart failure, and atrial fibrillation (AF). However, its predictive efficacy for AF recurrence after ablation remains underexplored. Objectives This study aimed to evaluate the predictive value of LACI, assessed by cardiac computed tomography (CT), for AF recurrence following ablation. Methods We performed a retrospective analysis of 130 AF patients who underwent cardiac CT before ablation at our institution from January 2019 to March 2021. LACI, defined as the ratio of left atrial to left ventricular volume during diastole, was analyzed using multivariate binary logistic regression to determine its association with AF recurrence. Kaplan–Meier survival curves assessed the duration of asymptomatic survival post-ablation. Results At 18 months, 29.2% (38/130) of patients experienced recurrence. Patients with recurrence had significantly higher LACI compared to those without (129.56 ± 48.02% vs. 84.58 ± 28.78%, P < 0.001). Multivariate analysis identified LACI as an independent risk factor for recurrence (OR = 9.51, 95% CI 1.99–45.34, P = 0.005), showing superior predictive capacity compared to the left atrial volume index (AUC: 0.815 vs. 0.779, P < 0.001). Kaplan–Meier curves demonstrated significantly lower cumulative AF recurrence-free survival in patients with LACI ≥ 89%. Conclusion LACI is a strong and independent predictor of AF recurrence post-ablation, offering superior risk discrimination over traditional left atrial and left ventricular parameters, thereby enhancing the clinical utility of cardiac CT before AF ablation.