Zhao Shu-Cai, Guo Hao, Lei Da-Zhou
Department of Cardiology Ward 1, Xinxiang Central Hospital, NO.56, Jinsui road, Xinxiang City, Henan Province, 453000, China.
BMC Cardiovasc Disord. 2025 Aug 4;25(1):578. doi: 10.1186/s12872-025-05023-w.
Recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFA) remains a major clinical challenge in patients with persistent AF. This study aimed to identify independent risk factors for post-ablation recurrence and to develop a nomogram prediction model integrating clinical, laboratory, and echocardiographic parameters.
In this retrospective study, 306 patients with persistent AF who underwent first-time RFA between June 2021 and June 2024 were enrolled. Patients were stratified into recurrence ( = 96) and non‐recurrence ( = 210) groups based on documented AF episodes during six-month follow-up. Preprocedural assessments encompassed three main domains: electrophysiological evaluations, echocardiographic measurements, and serum biomarkers. Multivariate logistic regression identified independent predictors of recurrence. A nomogram was constructed and internally validated using bootstrap resampling. Predictive performance was assessed by area under the receiver operating characteristic curve (AUC), calibration analysis, and decision curve analysis (DCA).
Elevated left atrial volume index (LAVI), reduced left atrial appendage emptying velocity (LAAEV), reduced left atrial appendage ejection fraction (LAAEF), elevated brain natriuretic peptide (BNP), and elevated neutrophil-to-lymphocyte ratio (NLR) emerged as independent predictors of AF recurrence (all < 0.05). The nomogram achieved an AUC of 0.893 (95% CI, 0.826–0.968), with sensitivity of 85.7% and specificity of 91.3%. Internal validation yielded a concordance index of 0.783 (95% CI, 0.722–0.869), and the Hosmer–Lemeshow test indicated good calibration ( = 0.851). DCA demonstrated a favorable net benefit across a range of threshold probabilities.
A nomogram incorporating LAVI, LAAEV, LAAEF, BNP, and NLR provides accurate individualized risk estimates for AF recurrence following RFA in persistent AF patients and may guide tailored clinical management.
对于持续性心房颤动（AF）患者，射频导管消融（RFA）术后房颤复发仍是一项重大临床挑战。本研究旨在确定消融术后复发的独立危险因素，并建立一个整合临床、实验室和超声心动图参数的列线图预测模型。
在这项回顾性研究中，纳入了2021年6月至2024年6月期间首次接受RFA的306例持续性AF患者。根据六个月随访期间记录的房颤发作情况，将患者分为复发组（n = 96）和非复发组（n = 210）。术前评估包括三个主要方面：电生理评估、超声心动图测量和血清生物标志物。多因素逻辑回归确定复发的独立预测因素。构建列线图并使用自助重采样进行内部验证。通过受试者操作特征曲线下面积（AUC）、校准分析和决策曲线分析（DCA）评估预测性能。
左心房容积指数（LAVI）升高、左心耳排空速度（LAAEV）降低、左心耳射血分数（LAAEF）降低、脑钠肽（BNP）升高和中性粒细胞与淋巴细胞比值（NLR）升高是房颤复发的独立预测因素（均P < 0.05）。列线图的AUC为0.893（95%CI，0.826 - 0.968），敏感性为85.7%，特异性为91.3%。内部验证得出一致性指数为0.783（95%CI，0.722 - 0.869），Hosmer - Lemeshow检验表明校准良好（P = 0.851）。DCA显示在一系列阈值概率范围内具有良好的净效益。
包含LAVI、LAAEV、LAAEF、BNP和NLR的列线图可为持续性AF患者RFA术后房颤复发提供准确的个体化风险估计，并可能指导个性化临床管理。
