A Nomogram Model For Predicting Recurrence After Catheter Ablation In Patients With Atrial Fibrillation

Background Atrial fibrillation is a complex and multi-factorial rhythm disorder.Catheter ablation is currently one of the most commonly performed electrophysiological procedures for atrial fibrillation and has been shown to maintain sinus rhythm better than antiarrhythmic drugs.However,not all patients have sinus rhythm restored by ablation and the rate of postoperative recurrence varies considerably among patients with atrial fibrillation with different clinical characteristics.Several factors have been shown to be predictors of postoperative recurrences,but the predictive efficacy of these variables alone is not high,so a clinical risk model to predict postoperative recurrence remains a critical and necessary need.Objective The aims of the study was to（1）explore the risk factors affecting the recurrence of atrial fibrillation after catheter ablation and develop a nomogram model to predict rhythm outcomes after catheter ablation;（2）validate it in an external cohort;（3）compare it with the APPLE and CAAP-AF score models.Methods Retrospective analysis of 571 consecutive patients with atrial fibrillation who underwent continuous catheter ablation at the Department of Cardiovascular Medicine,The First Affiliated Hospital of Anhui Medical University from January 2018 to December 2019,after a median follow-up of 24 months,221 patients with postoperative recurrence were found.They were randomly divided into development set（390 cases）and avalidation set（181 cases）,and the clinical baseline data,haematology and cardiac ultrasound imaging of all patients were queried through the hospital case management system,and their comparative analysis were performed;In the development set,univariate and multivariate Logistic regression analysis were used to determine independent predictors of atrial fibrillation recurrence after catheter ablation,R software was used to establish a nomogram model to predict atrial fibrillation recurrence after catheter ablation and its internal and external validation,efficacy evaluation and comparison with common APPLE and CAAP-AF prediction models were conducted.Results There were no significant differences in age,course of AF,Blood lipid of the five,creatinine and left atrial diameter（LAD）between the two groups in the development set and validation set.In development set,univariate and multivariate Logistic regression analysis showed that atrial fibrillation type,body mass index（BMI）,LAD,neutrophil to lymphocytic ratio（NLR）were independent risk factors for postoperative recurrence of atrial fibrillation（OR of 2.744,1.090,2.716,2.202,P < 0.05 for each group）,and the consistency index of the established a nomogram model for predicting recurrence after catheter ablation was 0.712（95%CI: 0.660-0.763）,and also supported by external validation（AUC:0.728,95%CI: 0.651-0.806）.The calibration curve showed that the predicted results of nomogram were in good agreement with the actual results.By drawing the ROC curves of the nomogram,APPLE and CAAP-AF prediction models,it is concluded that the AUC of the newly constructed the nomogram model is 0.712,which is higher than that of the latter（APPLE: 0.636;CAAP-AF:0.662）,and the difference in AUC among all models was statistically significant（P<0.05）.Conclusion This study confirms that the type of AF,LAD,BMI and NLR are independent predictors of recurrence after catheter ablation in patients with AF,and the column line graph model constructed in this way can effectively predict recurrence in patients with AF and has good clinical application.