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Introduction: The objective of this study was to identify the simple preprocedural parameters of atrial fibrillation (AF) recurrence following single ablation procedure in patients with paroxysmal AF during long-term follow-up period., Methods and Results: Consecutive 474 patients (61 ± 10 years; 364 males, left atrial (LA) diameter 37.6 ± 5.1 mm) with drug-refractory paroxysmal AF who underwent AF ablation were analyzed. Pulmonary vein antrum isolation (PVAI), cavotricuspid isthmus line creation with bidirectional conduction block, and elimination of all non-PV triggers of AF were performed in all patients. With a mean follow-up of 30 ± 13 months after single procedure, 318 patients (67.1%) were in sinus rhythm without any antiarrhythmic drugs. Multivariate analysis using Cox's proportional hazards model, including the age, gender, duration of AF, body mass index, LA size, left ventricular ejection fraction, and presence of hypertension and structural heart disease as variables, demonstrated that LA size was an independent predictor of AF recurrences after PVAI with a 7.2% increase in the probability for every 1 mm increase in LA diameter (P = 0.0007). When the patients were categorized into 3 groups according to the LA diameter, the patients with moderate (40-50 mm) and severe dilatation (>50 mm) had a 1.30-fold (P = 0.0131) and 2.14-fold (P = 0.0057) increase, respectively, in the probability of recurrent AF as compared with the patients with normal LA diameter (≤40 mm)., Conclusion: In the long-term follow-up period, LA size was the best preprocedural predictor of AF recurrence following single ablation procedure in the patients with paroxysmal AF, even in the patients with a relatively small LA., (© 2011 Wiley Periodicals, Inc.)