Objective To investigate the correlation of left atrial low-voltage zones (LVZs) with atrial fibrillation (AF) recurrence after pulmonary vein (PV) antrum isolation (PVAI) in paroxysmal AF patients. Methods A total of 168 consecutive patients [92 males and 76 females, with age of (62±11) years] who underwent PVAI for treating AF in our department were enrolled in this study. High density (≥100 points) left atrial voltage maps were reconstructed during sinus rhythm using CARTO 3 system. LVZs were defined as areas with bipolar peak-to-peak voltage amplitudes ＜0.5mV. In 20min after PVAI, all patients were given intravenous injection of isoproterenol and adenosine triphosphate (ATP, 0.2 mg/kg) in an attempt to unmask PV reconnection and AF triggered by non-PV foci. If PV reconnection and non-PV foci were elicited, additional ablation was carried out till provocative test became negative. Results Voltage maps revealed LVZs in 42 patients (25%) but not in the other 126 patients (75%). The LVZs were distributed on the anterior wall in 22 patients (22/42, 52.4%), and correlated with female and larger left atrial diameter. PVAI was completed in all these patients. During (23±12) months of follow-up, 14 patients (14/42, 33.3%) with LVZs and 21 (21/126, 16.7%) without LVZs had AF recurrences (P＝0.028). Conclusion LVZs in paroxysmal AF patients increase the recurrence after PVAI, which might be correlated with gender and left artial diameter.