Development and validation of a nomogram model based on inflammatory markers and cardiac parameters: predicting the risk of recurrence in patients with atrial fibrillation after radiofrequency catheter ablation

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial Fibrillation (n=516). Intervention: Radiofrequency Catheter Ablation. Primary outcome: Recurrence of atrial fibrillation (AF) after radiofrequency ablation.

Jiaming Meng; Tiantian Zhang; Liubing Zhu; Sutong Li; Linli Zhang; Liu Miao; Yanli Liu

doi:10.1186/s12872-026-05704-0

March 13, 2026BMC Cardiovascular DisordersOpen Access

Development and validation of a nomogram model based on inflammatory markers and cardiac parameters: predicting the risk of recurrence in patients with atrial fibrillation after radiofrequency catheter ablation

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Key result

Larger LAD is linked to ~8% higher AF recurrence per mm post-ablation, while higher LVEF protects.

n=516

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Why the study?

This study aimed to identify independent predictors of recurrence after catheter ablation for AF and develop a nomogram for individualized risk assessment.

Key Points

To identify independent predictors of atrial fibrillation recurrence following radiofrequency catheter ablation and construct an individualized predictive nomogram.
Retrospectively analyzed 516 patients undergoing first-time radiofrequency catheter ablation for atrial fibrillation between July 2020 and May 2025 at Liuzhou People's Hospital.
Divided the cohort into training and validation sets at a 7:3 ratio using stratified random sampling.
Identified risk factors via univariate and multivariate Cox proportional hazards regression with restricted cubic splines, evaluating discrimination, calibration, and clinical utility with decision curve analysis.
The predictive nomogram incorporated five independent factors: left atrial diameter, left ventricular ejection fraction, type of atrial fibrillation, D-dimer, and neutrophil-to-lymphocyte ratio.
The nomogram achieved a C-index of 0.731, with calibration curves demonstrating strong concordance between predicted and observed one-year recurrence.
Decision curve analysis verified clinical net benefit across a threshold probability range of 10% to 50%.

Study Design

Type

Cohort (n=516)

Multicenter

No

Structured PICO

P

Population

516 patients with symptomatic paroxysmal (59.1%) or persistent (40.9%) atrial fibrillation undergoing first-time catheter radiofrequency ablation, mean age 63.11, 63.18% male, based in Guangxi, China. Excluded: severe hepatic/renal dysfunction, thyroid dysfunction, malignancy, concomitant organic heart disease, or end-stage heart failure.

I

Intervention

First-time catheter-based radiofrequency ablation (pulmonary vein isolation using the quantitative CLOSE protocol)

O

Outcome

Recurrence of atrial fibrillation, atrial flutter (AFL), or atrial tachycardia (AT) lasting more than 30 seconds, confirmed by 12-lead ECG or 24-hour ambulatory ECG, after a 3-month blanking period post-procedurecomposite

A novel nomogram incorporating clinical, echocardiographic, and inflammatory markers (including NLR) provides moderate predictive accuracy (C-index 0.731) for identifying patients at high risk of AF recurrence after first-time radiofrequency ablation.

Limitations

The study is retrospective in nature, which may introduce biases.
Findings may lack generalizability beyond the specific population studied.

Implication

Supports improved risk stratification for AF recurrence after ablation; extends prior models but should not yet change practice pending validation.

Abstract

This study aimed to identify independent predictors of recurrence after catheter ablation for atrial fibrillation (AF) and develop a nomogram for individualized risk assessment. Data from 516 AF patients undergoing first-time radiofrequency ablation between July 2020 and May 2025 were retrospectively analyzed. Univariate and multivariate Cox regression identified independent risk factors, with restricted cubic spline (RCS) analyzing dose-response relationships for continuous variables. Patients were divided into training and validation sets (7:3 ratio) via stratified random sampling. The nomogram was evaluated using the C-statistic, calibration plots, and decision curve analysis (DCA) for discrimination, calibration, and clinical utility. The nomogram incorporated left atrial diameter (LAD), left ventricular ejection fraction (LVEF), type of AF, D-dimer (DD), and neutrophil-to-lymphocyte ratio (NLR). It demonstrated a C-index of 0.731. Calibration curves indicated strong agreement between predicted and observed outcomes, and DCA confirmed clinical net benefit within a 10%–50% threshold probability range. The nomogram provides accurate, individualized prediction of one-year post-ablation AF recurrence risk, facilitating early identification of high-risk patients and offering valuable prognostic insight.

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Cite This Study

Meng et al. (2026) conducted a cohort in Atrial Fibrillation (n=516). Radiofrequency Catheter Ablation was evaluated on Recurrence of atrial fibrillation (AF) after radiofrequency ablation. Increasing left atrial diameter (LAD) was associated with an 8.2% increase in AF recurrence risk for every 1 mm increase (HR 1.082), while a 1% increase in left ventricular ejection fraction (LVEF) was linked to a 4.6% decrease in recurrence risk (HR 0.954).

synapsesocial.com/papers/69b64d48b42794e3e660e13c https://doi.org/10.1186/s12872-026-05704-0