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Background: The relationship between the incidence of paroxysmal atrial fibrillation (PAF) and persistent elevated left atrial (LA) pressure caused by left ventricular (LV) diastolic dysfunction has been reported. Objective: To investigate LA function in patients with PAF using three-dimensional (3D) speckle tracking imaging.Method: A total of 159 subjects (103 males; mean age 61 ± 15 years) including patients with PAF (n = 48) and hypertension (HT; n = 47) and 64 controls were enrolled. They underwent conventional and 3D echocardiography to obtain the LA volume and LA emptying fraction (LAEF). The LA wall strain was analyzed by 3D area tracking imaging, and the maximal value of global area strain curve was defined as peak global strain.Result: 73 % of PAF patients had hypertension. There were no significant differences in LV dimension and LV ejection fraction among three groups. LV mass index was larger in HT (P = 0.001) and PAF (P = 0.002) than in controls. Ea was lower in HT (P < 0.0001) and PAF (P < 0.0001) than in controls and E/Ea was higher in HT (P < 0.0001) and PAF (P < 0.0001) than in controls. The maximal LA volume index was 20.8 ± 4.6 ml/m2 in controls, 25.5 ± 8.3 ml/m2 in HT, and 30.7 ± 12.8 ml/m2 in PAF. LAEF and peak global strain did not differ between HT and controls. LAEF was lower in PAF than HT and controls (P < 0.0001 and P < 0.0001, respectively) and peak global strain was also lower in PAF than HT and controls (P < 0.0001 and P < 0.0001, respectively). Multivariate analysis revealed peak global strain was the strongest factor to predict PAF.Conclusion: The development of PAF may be associated with pathological dysfunction of LA following physiological LA compensation. 3D speckle tracking imaging was useful to evaluate LA function in patients with PAF.