Risk factors and nomogram prediction model for recurrence after radiofrequency ablation in patients with persistent atrial fibrillation.

BACKGROUND: 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. METHODS: 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 (n = 96) and non‐recurrence (n = 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). RESULTS: 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 P < 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 (P = 0.851). DCA demonstrated a favorable net benefit across a range of threshold probabilities. CONCLUSIONS: 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.