Objective To investigate the predictive value of CT measurements of left atrium and pulmonary vein diameter for recurrence after radiofrequency catheter ablation (RFCA) in patients with primary atrial fibrillation. Methods Sixty-six patients with paroxysmal atrial fibrillation who were diagnosed as atrial fibrillation in the Affiliated Hospital of Chengde Medical University and underwent radiofrequency ablation for the first time were selected as the lesion group, and 40 healthy people were selected as the control group. All patients underwent CT angiography of left atrium and pulmonary vein. The transverse diameter and area of left atrium, the diameter and area of pulmonary vein opening, and the ratio of atrium to vertebra were measured, and the data were analyzed between groups. CT examination was performed again 3, 6 and 12 months after operation. According to the follow-up of patients, the patients were divided into recurrence group and cure group. The data of recurrence group and cure group were compared and analyzed. Results There were significant differences in the area of right superior pulmonary vein (RSPV), the anterior and posterior diameter and area of right inferior pulmonary vein (RIPV), and the diameter and area of left superior pulmonary vein (LSPV) between the observation group and the control group (P<0.05). There were significant differences in the left atrio-vertebral area ratio (LAVA), the left atrio-vertebral diameter ratio (LAVD), the area of RSPV and the anterior and posterior diameter of RIPV between the recurrence group and the cure group (P<0.05). Logistic regression analysis showed that LAVA was an independent risk factor for RFCA recurrence. Conclusion CT measurements of left atrium and pulmonary vein are closely related to the recurrence rate of atrial fibrillation after RFCA, and LAVA can be used as an independent predictor of recurrence after RFCA.