Development and validation of a predictive model for atrial fibrillation recurrence post–catheter ablation in patients with nonvalvular atrial fibrillation on the basis of hemodynamic parameters

IF 5.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Heart rhythm Pub Date : 2024-09-03 DOI:10.1016/j.hrthm.2024.08.058

Decai Zeng MD, Shuai Chang MD, Xiaofeng Zhang MD, Yanfen Zhong MD, Yongzhi Cai MD, Tongtong Huang MD, Ji Wu MD, PhD

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Abstract

Background

The influence of hemodynamic parameters on the recurrence of atrial fibrillation (AF) after catheter ablation is not well known, and it remains unclear whether a nomogram combining risk factors and hemodynamic parameters improves prediction accuracy.

Objective

This study aimed to develop a nomogram on the basis of echocardiographic hemodynamic parameters for predicting AF recurrence after catheter ablation in nonvalvular atrial fibrillation (NVAF).

Methods

A total of 380 consecutive patients with NVAF undergoing AF catheter ablation treatment were prospectively included. Patients were divided into training and validation cohorts in a 7:3 ratio. The follow-up time averaged 9 months with a median of 12 months, during which 132 patients (34.7%) experienced AF recurrence.

Results

Least absolute shrinkage and selection operator regression and Cox regression analyses identified 4 significant predictors of AF recurrence: persistent AF (hazard ratio [HR] 1.63; 95% confidence interval [CI] 1.02–2.61; P = .041), S/D ratio of pulmonary vein (HR 0.50; 95% CI 0.30–0.84; P = .009), left atrial acceleration factor α (HR 1.31; 95% CI 1.02–1.68; P = .032), and left atrial appendage peak emptying flow velocity (HR 0.98; 95% CI 0.97–0.99; P = .004). On the basis of these 4 variables, a predictive nomogram was constructed. The nomogram demonstrated C indices of 0.664 and 0.728 for predicting 1- and 2-year AF recurrence, respectively, in the validation cohort. The Kaplan-Meier survival analysis indicated that a Nomo score of >128 was associated with a higher risk of AF recurrence.

Conclusion

Hemodynamic parameters may offer valuable insight into predicting AF recurrence after catheter ablation. Our study successfully developed a reliable nomogram on the basis of echocardiographic hemodynamic parameters to estimate the risk of AF recurrence after catheter ablation in patients with NVAF.

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基于血液动力学参数，开发并验证非瓣膜性心房颤动患者导管消融术后心房颤动复发的预测模型。

背景：血液动力学参数对导管消融术后心房颤动（房颤）复发的影响尚不十分清楚，将风险因素和血液动力学参数相结合的提名图是否能提高预测的准确性仍不明确：本研究旨在开发一种基于超声心动图血液动力学参数的提名图，用于预测非瓣膜性心房颤动（NVAF）导管消融术后的房颤复发：方法：前瞻性地收集了380例连续接受房颤导管消融治疗的非瓣膜性心房颤动患者。患者按 7:3 的比例分为训练组和验证组。随访时间平均为 9 个月，中位数为 12 个月，期间有 132 名患者（34.7%）出现房颤复发：结果：LASSO 回归和 Cox 回归分析确定了房颤复发的四个重要预测因素：持续性房颤（HR=1.63，95% CI=1.02∼2.61，P=0.041）、收缩压/舒张压（S/D）比值（HR=0.50，95% CI=0.30∼0.84，P=0.009）、左房加速因子α（HR=1.31，95% CI=1.02∼1.68，P=0.032）和左房阑尾峰值排空流速（HR=0.98，95% CI=0.97∼0.99，P=0.004）。根据这四个变量，构建了一个预测提名图。在验证队列中，该提名图预测 1 年和 2 年房颤复发的 C 指数分别为 0.664 和 0.728。Kaplan-Meier生存分析表明，Nomo评分大于128与房颤复发风险较高有关：结论：血液动力学参数可为预测导管消融术后房颤复发提供有价值的见解。我们的研究根据超声心动图血流动力学参数成功开发了一种可靠的提名图，用于估计 NVAF 患者导管消融术后房颤复发的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.