# Analysis of risk factors for early recurrence after radiofrequency ablation in patients with atrial fibrillation and construction of a nomogram predictive model

## TL;DR

This study identifies risk factors for early recurrence of atrial fibrillation after ablation and builds a model to predict individual risk.

## Contribution

A novel nomogram model is developed for individualized risk assessment of early recurrence after radiofrequency ablation for atrial fibrillation.

## Key findings

- Elevated BMI, enlarged left atrial diameter, increased BNP, persistent AF, and OSAS are independent predictors of early recurrence.
- The nomogram model demonstrated good discrimination and calibration for predicting early recurrence.
- The model's clinical utility was confirmed through decision curve analysis.

## Abstract

Early recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation remains common and undermines procedural success. This study aimed to identify clinical, echocardiographic, and biochemical predictors of early atrial tachyarrhythmia recurrence and to construct a nomogram for individualized risk assessment.

This retrospective cohort study included 276 consecutive patients with AF undergoing first-time radiofrequency catheter ablation between January 2021 and December 2024. Early recurrence was defined as any documented AF, atrial flutter, or atrial tachycardia lasting ≥30 s within 3 months post-procedure. All patients received short-term oral amiodarone for 3 months to cover the 90-day blanking period. Multivariable logistic regression was used to identify independent predictors. A nomogram was developed using the rms package in R. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Internal validation and calibration were assessed using bootstrap resampling (1,000 iterations) with an optimism-corrected concordance index (C-index) and calibration plots, and clinical utility was evaluated using decision curve analysis (DCA).

Univariate analysis showed higher body mass index (BMI), larger left atrial diameter (LAD), higher B-type natriuretic peptide (BNP) levels, and higher prevalences of dyslipidemia, obstructive sleep apnea syndrome (OSAS), and persistent AF in patients with early recurrence (all p < 0.05). Multivariable analysis identified BMI (per 1 kg/m2; OR 1.753, 95% CI 1.443–2.113; p < 0.001), LAD (per 5 mm; OR 1.556, 95% CI 1.152–2.102; p = 0.004), BNP (per 100 ng/L; OR 1.703, 95% CI 1.373–2.053; p < 0.001), persistent AF (OR 4.203, 95% CI 1.324–13.507; p = 0.017), and OSAS (OR 3.405, 95% CI 1.081–11.005; p = 0.041) as independent predictors. The nomogram showed acceptable discrimination (AUC 0.761, 95% CI 0.693–0.851), stable internal validation (optimism-corrected C-index 0.758), good calibration, and favorable net clinical benefit on DCA.

Elevated BMI, enlarged LAD, increased BNP, persistent AF, and OSAS independently predict early atrial tachyarrhythmia recurrence after ablation. This nomogram may support individualized early post-ablation risk stratification, pending external validation in multicenter cohorts.