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Background  Left atrial (LA) enlargement has been identified as a predictor of worse clinical outcome after catheter ablation for atrial fibrillation (AF). We investigated the correspondence of LA size parameters assessed by echocardiography, CT and 3D electroanatomical mapping in patients with AF treated by catheter ablation.    Methods  We analyzed echocardiographic LA volume measurements by disc summation method (LAV DISC ), computed tomography (LAV CT ) and 3D electroanatomical mapping (LAV CARTO ) in 100 pts. (71% males; aged 63 ± 8 years; paroxysmal AF in 55% of patients).    Results  Mean LAV DISC  was 83 ± 25 ml (median: 115; IQR: 98–140 ml), mean LAV CT  was 120 ± 34 ml (median: 115; IQR: 98–140 ml) and mean LAV CARTO  was 123 ± 36 ml (median: 118; IQR: 99–132 ml). Pearson’s correlation coefficient between LAV DISC  a LAV CT  was 0.6 ( p  < 0.0001) and between LAV CARTO  and LAV CT  was 0.79 (p < 0.0001). There was a significant difference between the two correlation coefficients ( p  < 0.004). The absolute difference between LAV CARTO  and LAV CT  (3.5 (95% CI -42 – 43) ml) was significantly lower ( p  < 0.0001) as compared to LAV DISC  and LAV CT  (− 39 (95% CI -102 – 24) ml). In opposite to LAV DISC , the bias between LAV obtained by CT and CARTO did not differentiate according to presence of spherical remodeling (1.7 ± 28 vs. vs. 5.1 ± 31 ml). Only presence of sinus rhythm was significant and independent covariate of the difference between CARTO and CT-derived LAVs by multivariate regression analysis.    Conclusions  Even though LA volumes evaluated by 3D-electroanatomical mapping have quite good accuracy, the precision is low. For volumes estimated by echocardiography, both precision and accuracy are low.

3D electroanatomical mapping is less sensitive to atrial remodeling in estimation of true left atrial volume than echocardiography