Background: In adult patients with systolic heart failure, the presence of adjacent, nonoverlapping E and A waves on Doppler echocardiography is associated with optimal cardiac output and favorable clinical outcomes. However, the clinical significance of echocardiographic overlap in patients with atrial fibrillation (AF) remains uncertain. This study aimed to explore the relationship between E-wave and A-wave overlap, assessed the day after catheter ablation, and the recurrence of atrial arrhythmias (AR) following AF ablation. Methods: Patients with AF who underwent first-time arrhythmia ablation were included in this study. Transthoracic echocardiography was performed on the day following catheter ablation to evaluate the presence of E- and A-wave overlap. The relationship between overlap length and recurrence of AR after AF ablation was analyzed. Results: The study included 175 patients (124 males; mean age: 68 years [range 52-79]; mean CHA2DS2-Vasc score: 2 [range 0?4]; and 93 with paroxysmal AF) who underwent AF ablation. There were no significant differences between the two groups in terms of heart failure history or echocardiographic parameters prior to catheter ablation. However, the absolute overlap length was significantly prolonged in the AR group (59 ms [range 9-160] vs. 120 ms [range 28.6-226]; P < .001). Furthermore, the rate of AR was significantly lower in the group without prolonged overlap length (HR, 0.15 [95% CI, 0.07-0.30]; P < .001). These findings were consistent across all AF types. Conclusions: The length of E-wave and A-wave overlap appears to be a significant predictor of AR following AF ablation.

The authors have declared no competing interest.

The authors (s) declare no financial support for the research, authorship, or publication of this article.

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Showa University Ethics Committee (ID: 2024-184-A)

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