Development and Validation of a Postoperative Prognostic Nomogram to Predict Recurrence in Patients with Persistent Atrial Fibrillation:A Retrospective Cohort Study

Background:Patients with persistent atrial fibrillation(PsAF)have a high risk of recurrence after catheter radiofre-quency ablation.Nevertheless,no effective prognostic tools have been developed to identify these high-risk patients to date.This study sought to develop and validate a simple linear predictive model for predicting postoperative recurrence in patients with PsAF.Methods:From June 2013 to June 2021,patients with PsAF admitted to our hospital were enrolled in this single-center,retrospective,observational study.The characteristics substantially associated with recurrence in patients with PsAF were screened through univariate and multivariate logistic regression analysis.The receiver operating charac-teristic curve was used to assess the predictive significance of the nomogram model after nomogram development.Furthermore,to assess the clinical value of the nomogram,we performed calibration curve and decision curve analyses.Results:A total of 209 patients were included in the study,42(20.10%)of whom were monitored up to 1 year for recurrent AF.The duration of AF episodes,left atrial diameter,BMI,CKMB,and alcohol consumption were found to be independent risk factors(P<0.05)and were integrated into the nomogram model development.The area under the curve was 0.895,the sensitivity was 93.3%,and the specificity was 71.4%,thus indicating the model’s excellent predic-tive ability.The C-index of the predictive nomogram model was 0.906.Calibration curve and decision curve analyses further revealed that the model had robust prediction and strong discrimination ability.Conclusion:This simple,practical,and innovative nomogram can help clinicians in evaluation of the risk of PsAF recurrence after catheter ablation,thus facilitating preoperative evaluation,postoperative monitoring and ultimately the construction of more personalized therapeutic protocols.

Effect of anxiety and depression on the recurrence of persistent atrial fibrillation after circumferential pulmonary vein ablation

Background The effects of anxiety and depression on the recurrence of persistent atrial fibrillation （AF） after circumferential pulmonary vein ablation （CPVA） are not clear. Whether CPVA can alleviate the anxiety and depression symptoms of persistent AF patients is unknown. Methods One hundred and sixty-four patients with persistent AF, of which 43 treated with CPVA （CPVA group） and 103 treated with anti-arrhythmics drugs （medicine group）, were enrolled. The Zung Self-Rating Anxiety Scale （SAS）, and Zung Self-Rating Depression Scale （SDS） were assessed before and 12 months after treatment in all patients. Results The scores of SAS （40.33±7.90 vs. 49.76±9.52, P 〈0.01） and SDS （42.33±8.73 vs. 48.17±8.77, P 〈0.01） decreased 12 months after CPVA. Over 12 months follow-up, AF relapsed in 17 patients in CPVA group. Compared with the data in the recurrent group （17 patients）, the scores of SAS and SDS were significantly lower in the non-recurrent group （26 patients） at baseline. The results of multivariate Logistic regression analysis showed normal scores of SAS and SDS were the independent risk factors of AF recurrence after CPVA. Conclusions Anxiety and depression increase the recurrence risk of persistent AF after CPVA. CPVA can ameliorate the anxiety and depression symptoms in patients with persistent AF.

Impact of different termination modes on atrial fibrillation termination in catheter ablation of persistent atrial fibrillation

Background The optimal endpoint for catheter ablation of persistent atrial fibrillation （AF） remains ambiguous. This study investigated the impact of AF termination as a procedural endpoint and the termination mode on long-term clinical outcome. Methods Two hundred and ninety-three patients who underwent stepwise ablation for persistent AF were categorized into the AF termination by ablation group and into the electrical cardioversion （CV） group. Subgroups were also analyzed based on different termination modes. Follow-up assessment included early recurrence and sinus rhythm （SR） maintenance. Results During initial ablation, 33 patients （11.3%） were directly converted to SR, 166 patients （56.7%） were converted to atrial tachycardia （AT） that subsequently restored SR with further ablation in 98 patients （33.4%）, and a total of 162 patients （55.3%） underwent cardioversion due to persistent atrial arrhythmias. Comparison between termination by ablation and termination by cardioversion in patients exhibiting AF or AT revealed that no significant difference was observed in early recurrence （38.2% vs. 43.8%, P=0.328） and SR maintenance （67.2% vs. 59.8%, P=0.198） during the （23±7） months follow-up. Even after repeat ablation, the SR maintenance continued to exhibit no statistical difference in above two groups （72.5% vs. 70.4%, P=0.686）. Further analysis of subgroups, however, demonstrated that patients with AF terminated directly to SR experienced better clinical outcomes than other subgroups （P 〈0.05）. Furthermore, atrial arrhythmias present during ablation have been implicated in prediction of recurrence mode： AF or AT （P 〈0.05）. Conclusions Termination as a procedural endpoint is not associated with favorable long-term SR maintenance in persistent AF. AF methods that convert arrhythmia directly to SR have, however, been linked with improved clinical outcomes, although conversions to AT may not be correlated. Atrial arrhythmias observed during the ablation may be used to predict the recurrence mode.

Three-dimensional Dominant Frequency Mapping Using Autoregressive Spectral Analysis of Atrial Electrograms of Patients in Persistent Atrial Fibrillation

Areas with high frequency activity within the atrium are thought to be 'drivers' of the rhythm in patients with atrial fibrillation (AF) and ablation of these areas seems to be an effective therapy in e-liminating DF gradient and restoring sinus rhythm. Clinical groups have applied the traditional FFT-based approach to generate the three-dimensional dominant frequency (3D DF) maps during electro-physiology (EP) procedures but literature is restricted on using alternative spectral estimation tech-niques that can have a better frequency resolution that FFT-based spectral estimation.