Predictive accuracy of left atrial strain parameters for risk of atrial fibrillation recurrence: a systematic review and meta-analysis

Background Clinical evidence, in recent years, has increased regarding the application of left atrial strain parameters for the prediction of atrial fibrillation (AF) recurrence. This study endeavors to assess the predictive power of these parameters for AF recurrence. Methods We systematically searched Cochrane Library, Embase, PubMed, and Web of Science from inception to October 20, 2025, for cohort studies investigating the association between AF recurrence and various left atrial strain parameters, including peak atrial longitudinal strain (PALS, P-wave-triggered), left atrial reservoir strain (LASr, R-wave-triggered), left atrial conduit strain (LAScd), and left atrial contraction strain (LASct). A random-effects model was used to pool risk ratios (RRs) and predictive performance metrics. Sensitivity analysis, publication bias assessment, and subgroup analysis were performed. Results Totally 25 studies covering 3,649 patients were included. The meta-analysis indicated that PALS and LASr measured before treatment were effective predictors for AF recurrence. Analyzed as categorical variables, both a higher PALS (RR = 0.08, 95% CI: 0.04–0.16) and a higher LASr (RR = 0.91, 95% CI: 0.86–0.96) were linked to a significantly lower risk of AF relapse. Treated as continuous variables, a 1-unit increase in PALS (RR = 0.88, 95% CI: 0.85–0.91) or LASr (RR = 0.93, 95% CI: 0.88–0.99) was associated with a pronounced lower risk of AF recurrence. The pooled AUC values for PALS and LASr were 0.75 and 0.78, respectively. The predictive power of other parameters was limited or unclear: LASct and LAScd measured before treatment, as well as LASr measured after treatment (either as a categorical variable or a continuous variable), failed to show significant predictive power (all P 0.05). Only for LASct measured after treatment as a continuous variable, each unit elevation in LASct was linked to a reduced risk of AF relapse (RR = 0.75, 95% CI: 0.63–0.91). Conclusion This study suggests that lower PALS and LASr values are associated with a higher risk of AF recurrence. In addition, PALS and LASr shows relatively favorable predictive performance for AF recurrence. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251182805 , identifier: CRD420251182805.