A Study Of The Predictive Effectiveness Of The Nomogram Based On NLR To The Risk Of Recurrence Of Paroxysmal Atrial Fibrillation After Radiofrequency Catheter Ablation

Objective: In recent years,the recurrence of paroxysmal atrial fibrillation after radiofrequency catheter ablation has received great attention.However,a model that can predict the risk of postoperative recurrence of paroxysmal atrial fibrillation is missing.The aim of this study was to explore the association between neutrophil-to-lymphocyte ratio(NLR)and the risk of recurrence of paroxysmal atrial fibrillation,and to establish a nomogram model based on NLR to predict the risk of recurrence of paroxysmal atrial fibrillation after radiofrequency catheter ablation.Methods: This study was a retrospective observational study.A total of 213 patients who has been diagnosed with paroxysmal atrial fibrillation received radiofrequency catheter ablation in the department of Cardiology,Yijishan Hospital,Wannan Medical College from July 1,2020 to March 31,2022 were included.Patients younger than 18 years old or older than 75 years old,detected left atrial thrombus by doppler transesophageal echocardiographic,or with atrial fibrillation due to acute coronary syndrome,idiopathic cardiomyopathy,or rheumatic heart disease were excluded.All patients stopped taking antiarrhythmic drugs before surgery and accepted radiofrequency catheter ablation in the DSA room after taking rivaroxaban anticoagulant therapy for at least 4 weeks.We followed-up the patients at 1,3,and 6months after the operation.Patients were informed that if chest tightness or palpitation occurred suddenly during the follow-up period,they should go to the local hospital immediately and complete 12-lead electrocardiogram or Holter examination.SPSS 26.0and R software(version 3.6.2)were used for statistical analysis for this study.General data,laboratory test data and routine echocardiogram results of patients were collected and summarized.Patients were randomly divided into a training set and a validation set according to a ratio of 6:4,and compared the data of the two groups of subjects.In the training set,multivariate Logistic regression analysis was used to determine the independent risk factors for recurrence of paroxysmal atrial fibrillation after radiofrequency catheter ablation,and constructed a nomogram model.Receiver operating characteristics(ROC)and calibration curve were used to verify the effectiveness of the prediction model in the training set and validation set respectively,area under curve(AUC)was used to analyze the predictive value of nomogram and decision curve analysis(DCA)was used to evaluate the clinical value of nomogram.Results: A total of 22 patients(10.33%)with paroxysmal atrial fibrillation recurred during follow-up visit after the operation.It was confirmed that the patients in the relapse group had significant statistical significance in NLR level,hypertensive history,brain natriuretic peptide(BNP)level and left atrial dimension(LAD)value than those in the non-relapsed group(P(27)0.05).After multivariate Logistic regression analysis,NLR(OR:1.461,95%CI:1.004-2.128,P=0.048),history of hypertension(OR:7.615,95%CI:1.350-42.955,P=0.021),BNP(OR:1.002,95%CI:1.000-1.005,P=0.038)and LAD(OR:1.144,95%CI:1.003-1.305,P=0.044)were independent risk factors for recurrence of paroxysmal atrial fibrillation after radiofrequency catheter ablation.A nomogram was established based on these four indexes and built ROC,to prove good predictive value in the training set(AUC=0.907,95%CI :0.846-0.969)and validation set(AUC=0.878,95%CI :0.797-0.959).DCA showed that the nomogram had good clinical application value in both training set and validation set.Conclusion: High levels of NLR was associated with the recurrence of paroxysmal atrial fibrillation after radiofrequency catheter ablation.The nomogram based on NLR,hypertension,BNP and LAD can predict the risk of recurrence of paroxysmal atrial fibrillation after radiofrequency catheter ablation.