Prediction Of Recurrence Risk After Catheter Radiofrequency Ablation In Patients With Paroxysmal Atrial Fibrillation

Objective: To establish and validate a clinical prediction model to assess the risk of recurrence in patients with atrial fibrillation(AF)after the first catheter radiofrequency ablation,and to explore the contribution of the prediction model to treatment decision-making.Method: The study was divided into two parts.Among the 433 patients with atrial fibrillation who underwent catheter radiofrequency ablation for the first time,they were divided into a training cohort and a validation cohort in a 7:3 ratio.Univariate Cox regression was initially used to identify factors associated with postoperative recurrence of AF in the training cohort.These identified factors were then included in a multivariate Cox regression,and a prediction model was established based on the Akaike information criterion(AIC)principle.Subsequently,receiver operating characteristic(ROC)curve,calibration curve,and decision curve analysis(DCA)were performed to assess the predictive discrimination,consistency,and clinical utility of the model in predicting AF recurrence.The above process was repeated in the validation cohort to assess the stability of the model.The aforementioned process was repeated for external validation in the 172 patients with AF who underwent catheter radiofrequency ablation for the first time.Moreover,the patients with AF were categorized into two groups based on their preoperative European Heart Rhythm Association(EHRA)score: asymptomatic group(1 point)and symptomatic group(2-4 points).Kaplan-Meier curve was utilized to illustrate the survival status of AF patients with postoperative recurrence,and Cox regression analysis was conducted to calculate the hazard ratio(HR)and 95% confidence interval(CI)for each group.Furthermore,the patients were classified into three groups based on their EHRA score: asymptomatic group(1 point),mild symptom group(2 points),and severe symptom group(3-4 points),to investigate the association between symptom severity and the risk of postoperative recurrence in AF patients.Results: In the first part,a total of 134(31%)patients experienced post-ablation AF recurrence at a median follow-up of 12 months.The prediction model was established based on six variables,namely age,coronary artery disease(CAD),heart failure(HF),hypertension,transient ischemic attack(TIA)or cerebrovascular accident(CVA),and left atrial diameter(LAD).The validation cohort demonstrated an area under curve(AUC)of 0.81(95%CI,0.75-0.87)for the prediction model,and the calibration curve demonstrated good agreement between the predicted probability of AF recurrence and the actual recurrence rate.The decision curve analysis(DCA)curve showed a predicted curve based on the model above the baseline curve.The validation cohort also showed similar results with an AUC of 0.77(95%CI,0.69-0.86).In the second part,the AUC in the externally validated cohort was 0.77(95% CI,0.68-0.84),the calibration curve showed good agreement between the predicted AF recurrence and the actual AF recurrence,and the DCA curve demonstrated that the predicted curve based on model higher than the base curve.AF patients were divided into asymptomatic group(1 point)and symptomatic group(2-4 points)according to the EHRA score before catheter ablation.The results showed that the presence or absence of symptoms in AF patients had no effect on the post-ablation recurrence risk(p =0.261),Cox regression analysis was performed,and the HR value was 1.52(95%CI,0.72-3.20,p=0.276).AF patients were further divided into asymptomatic group(1 point),mild symptom group(2 points)and severe symptom group(3-4points)according to the EHRA score before catheter ablation.The post-ablation recurrence risk was affected by the severity of symptoms(p=0.003).Cox regression analysis showed that the HR value of the mild symptom group was 1.14(95%CI,0.52-2.51,p=0.749)compared with the asymptomatic group;The HR value of the severe symptoms group relative to the asymptomatic group was 2.36(95%CI,1.06-5.26,p=0.035).Conclusions: A clinical prediction model including age,CAD,HF,hypertension,TIA or CVA,and LAD was established and validated to evaluate the risk of postoperative recurrence in AF patients,which demonstrated good discriminative ability and consistency in predicting AF post-ablation recurrence and aided in clinical decision-making.Furthermore,the severity of preoperative symptoms in AF patients was found to be associated with the risk of post-ablation recurrence.