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Background Atrial fibrillation (AF) increases the left atrial (LA) volume and deteriorates LA function. Whether successful radiofrequency catheter ablation (RFCA) of persistent AF can reverse this process has not been yet established. Methods Patients with persistent AF undergoing RFCA were evaluated with pre- and post- (at 6-months of follow-up) procedural multislice computed tomography (MSCT). The LA functions were assessed through LA time-volume curves. Results The study population consisted of 44 patients [age 64 (interquartile ranges: 58, 70) years old, 93% male]. Among those, 31 patients (70%) maintained sinus rhythm during the follow-up (no recurrence group; NR group). The remaining 13 patients were classified as the recurrence group (R group). A significant decrease in the minimal and maximal LA volumes was observed in both groups, although this was less pronounced in the R group. Only the NR group had an improvement in the LA expansion index [18% (13, 25) vs. 37% (23, 43), p < 0.001], ejection fraction [15% (11, 20) vs. 27% (19, 30), p < 0.001] and conduit function [17 ml/m² (13, 20) vs. 25 ml/m² (20, 34), p < 0.001]. An improvement of LV function was also observed only in the NR group. Conclusions LA anatomical and functional reverse remodeling after RFCA of persistent AF was demonstrated by MSCT during follow-up, which was more pronounced in patients without AF recurrence. [ABSTRACT FROM AUTHOR]