Abstract Body (Do not enter title and authors here): Background: Atrial fibrillation recurrence (AF) after catheter ablation (CA), particularly with pulmonary vein isolation (PVI), continues to pose a significant clinical burden. Emerging evidence suggests that left atrial conduction velocity (LACV) may serve as a prognostic marker for recurrence; however, its predictive value in patients undergoing radiofrequency ablation limited strictly to PVI remains unclear.

Methods: PubMed, Scopus, and Embase were systematically searched from inception to May 2025 to identify studies that utilized radiofrequency CA with PVI. Continuous outcomes were pooled using the inverse variance method under a random-effects model and reported as mean differences (MD) with 95% CIs. Adjusted odds ratios (aORs) were pooled using the same approach and presented with 95% CIs. Pairwise meta-analysis was conducted using Review Manager version 5.4.1. Diagnostic test accuracy meta-analysis was performed using Meta-Disc version 2.0, with pooled sensitivity and specificity estimated through a univariate random-effects model.

Results: Five studies comprising a total of 592 patients (AF recurrence = 149; no AF recurrence = 443) were included. The LACV was significantly lower in patients with AF recurrence compared to those without, in both the anterior and posterior regions (MD: −0.21, 95%CI: −0.28, −0.14, p<0.00001; MD: −0.14, 95% CI: −0.23, −0.05, p= 0.002, respectively). Pooled analysis demonstrated that anterior LACV was a significant predictor of AF recurrence (aOR: 1.38, 95% CI: 1.18, 1.63, p<0.0001). In contrast, posterior LACV did not show a significant association (OR: 1.31, 95% CI: 0.96, 1.80). Diagnostic test accuracy meta-analysis confirmed that the anterior LACV was an accurate predictor of AF recurrence after PVI, a sensitivity of 87.6% (95% CI: 0.69, 0.96), and a specificity of 73.2% (95% CI: 0.68, 0.78).

Conclusion: This meta-analysis demonstrates that reduced anterior LACV is significantly associated with AF recurrence following radiofrequency CA limited to PVI. Anterior LACV offers strong diagnostic accuracy and may serve as a valuable non-invasive marker for risk stratification and clinical decision-making in patients undergoing PVI for AF.