Predictive value of ultrasound and clinical indicators in atrial fibrillation recurrence after radiofrequency ablation in patients of atrial fibrillation with heart failure

Chen Tingting; Zhang Bei; Sun Bing

doi:10.3760/j.issn.1673-4777.2024.01.004

Abstract：Objective To predict risk factors for atrial fibrillation(AF)recurrence in patients of AF with heart failure(AF-HF)after radiofrequency ablation by ultrasound and clinical indexes,and to establish a prediction model.Methods Totally 110 AF-HF patients who underwent radiofrequency ablation in the Affiliated Hospital of Guizhou Medical University from November 2020 to June 2022 were retrospectively selected.Clinical data and echocardiogram indicators of patients at admission were retrospectively recorded.Patients were followed-up at 3,6 and 12 months after discharge,and they were divided into recurrence group and non-recurrence group according to the recurrence of AF.Risk factors affecting AF recurrence were analyzed,and a prediction model was established.Results During follow-up,40 cases had AF recurrence(recurrence group),and other 70 cases had no(non-recurrence group).Compared to non-recurrence group,the male rate in the recurrence group was lower,and age,persistent AF rate,AF duration,stroke rate,bleeding history rate,CHA2DS2-VASc score,and N-terminal pro-brain natriuretic peptide(NT-proBNP)level in recurrence group were greater/higher/longer(all P＜0.05).Compared to non-recurrence group,left atrial appendage peak flow velocity in recurrence group was lower,and left atrial diameter(LAD),tricuspid regurgitation velocity and estimated pulmonary systolic blood pressure in recurrence group were higher(all P＜0.05).Binary Logistic regression analysis showed that AF duration,stroke,NT-proBNP and LAD were independent risk factors for AF recurrence(all P＜0.05),and all above of them were enrolled into prediction model.Receiver operating characteristic curve analysis showed that the area under the curve(AUC)of stroke,LAD,NT-proBNP and AF duration were 0.69[95％confidence interval(CI):0.58-0.73],0.73(95％CI:0.64-0.77),0.72(95％CI:0.66-0.79)and 0.71(95％CI:0.64-0.78),respectively,and the area under the curve of the prediction model was 0.83(95％CI:0.73-0.86).The consistency index of the prediction model was 0.79(95％CI:0.65-0.98,P＜0.05),and the absolute standard error between the model calibration curve and the actual curve was 0.037.Conclusion AF duration,stroke,NT-proBNP and LAD are independent risk factors for AF recurrence in patients with AF-HF after catheter radiofrequency ablation.The nomogram prediction model is constructed from the above indicators,which has better performance in predicting the risk of AF recurrence.