Zeng Decai, Chang Shuai, Zhang Xiaofeng, Zhong Yanfen, Cai Yongzhi, Huang Tongtong, Wu Ji
Department of Ultrasonic Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.
Department of Ultrasonic Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.
Heart Rhythm. 2025 Apr;22(4):900-913. doi: 10.1016/j.hrthm.2024.08.058. Epub 2024 Sep 3.
The influence of hemodynamic parameters on the recurrence of atrial fibrillation (AF) after catheter ablation is not well known, and it remains unclear whether a nomogram combining risk factors and hemodynamic parameters improves prediction accuracy.
This study aimed to develop a nomogram on the basis of echocardiographic hemodynamic parameters for predicting AF recurrence after catheter ablation in nonvalvular atrial fibrillation (NVAF).
A total of 380 consecutive patients with NVAF undergoing AF catheter ablation treatment were prospectively included. Patients were divided into training and validation cohorts in a 7:3 ratio. The follow-up time averaged 9 months with a median of 12 months, during which 132 patients (34.7%) experienced AF recurrence.
Least absolute shrinkage and selection operator regression and Cox regression analyses identified 4 significant predictors of AF recurrence: persistent AF (hazard ratio [HR] 1.63; 95% confidence interval [CI] 1.02-2.61; P = .041), S/D ratio of pulmonary vein (HR 0.50; 95% CI 0.30-0.84; P = .009), left atrial acceleration factor α (HR 1.31; 95% CI 1.02-1.68; P = .032), and left atrial appendage peak emptying flow velocity (HR 0.98; 95% CI 0.97-0.99; P = .004). On the basis of these 4 variables, a predictive nomogram was constructed. The nomogram demonstrated C indices of 0.664 and 0.728 for predicting 1- and 2-year AF recurrence, respectively, in the validation cohort. The Kaplan-Meier survival analysis indicated that a Nomo score of >128 was associated with a higher risk of AF recurrence.
Hemodynamic parameters may offer valuable insight into predicting AF recurrence after catheter ablation. Our study successfully developed a reliable nomogram on the basis of echocardiographic hemodynamic parameters to estimate the risk of AF recurrence after catheter ablation in patients with NVAF.
血流动力学参数对导管消融术后心房颤动（AF）复发的影响尚不明确，且结合危险因素和血流动力学参数的列线图是否能提高预测准确性仍不清楚。
本研究旨在基于超声心动图血流动力学参数开发一种列线图，用于预测非瓣膜性心房颤动（NVAF）患者导管消融术后AF复发情况。
前瞻性纳入380例连续接受AF导管消融治疗的NVAF患者。患者按7:3的比例分为训练队列和验证队列。随访时间平均为9个月，中位数为12个月，在此期间132例患者（34.7%）出现AF复发。
最小绝对收缩和选择算子回归及Cox回归分析确定了AF复发的4个显著预测因素：持续性AF（风险比[HR]1.63；95%置信区间[CI]1.02 - 2.61；P = 0.041）、肺静脉S/D比值（HR 0.50；95%CI 0.30 - 0.84；P = 0.009）、左心房加速因子α（HR 1.31；95%CI 1.02 - 1.68；P = 0.032）和左心耳峰值排空流速（HR 0.98；95%CI 0.97 - 0.99；P = 0.004）。基于这4个变量构建了预测列线图。该列线图在验证队列中预测1年和2年AF复发的C指数分别为0.664和0.728。Kaplan-Meier生存分析表明，Nomo评分>128与AF复发风险较高相关。
血流动力学参数可能为预测导管消融术后AF复发提供有价值的见解。我们的研究成功地基于超声心动图血流动力学参数开发了一种可靠的列线图，以估计NVAF患者导管消融术后AF复发的风险。
